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owed no. <br /> z.4 .1.j awitrateri7.AM EPA ID IVb,•' ,i 7 y.: [ x r <br /> Fe <br /> I •F' ti t' <br /> ' 6. Treneptxtrx 1 <br /> 7 Transporter 2 '� <br /> .•�..i a r �• [` Ul•4. r A 10 <br /> 1 I <br /> tia- <br /> dr l L X. <br /> i >Z ,. � .t�ttr Hm:ard Ctl41s, .+ �,r�r I"ry;�• 1.� ttpt@,+• •'.r <br /> ki �r •t ��1 y ; ,•� ` I �i _ t�. _ ., r �t:�a`` r �r,M�' ��� ., � J'j�.•' � ; R„1 <br /> ; •t1 tt^ t r i <br /> ZIA <br /> ' w <br /> 3` � 3� 7�.��� r o•{t it *�� <br /> •s+�.� ,d- EPA/O:Zvr•u�::-�.. • <br /> State <br /> EPA/Other'. <br /> J-Addi cd Above: K handling r <br /> a• ng Cosies fortrtoobtoe Listed Alwvo <br /> a. <br /> r QI `•�C. 1 fin.:-:('•i .'�':r ��.y!^' j` �L ` <br /> ;A” <br /> 'r_ <br /> c. (d. <br /> Qi •y jF s e r <br /> �' `•r .�..: ..�i; r: III <br /> 16. Special MaudlinIIts ructlorte and Additional information <br /> s911,ec/,�cs>T�. or�crs4W ,IZo7�r�— �, Q. <br /> ` 835 <br /> GENERATOJt'S CEPTIFtCATIOM, 1 hereby declare that tho contents of this consignment are fully and accurately described above by proper chipping <br /> name and are claeoltiod;:.peackod marked..and labeled, and are Ina respects in orr condition for transport by highway raccording to applicable <br /> international and national govmm <br /> oent regulations. J// , <br /> If I em o large quantity gonorator.I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have <br /> determined to be eConomicagy practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to <br /> me which minimizes the prevent and future threat to human health and environment; OR, if I am a small quantity generator, (have made a good <br /> faith effort to minimize my wooto generation and select the best want an gement isPod that is available to me and that 1 can afford. <br /> Pr' /Ty s oma S t Month Day Year <br /> R 17. Tro porton 1 Ackn nt of Receipt df MmtoAgls _ <br /> A Print d/Typed Name <br /> N +, t .1Month Day Year <br /> S <br /> P 0 S <br /> 0 19: Transporter 2 Acknowledgement of Receipt of materials <br /> TPrinted/Typed Name <br /> E <br /> Signature k7onM Day Year <br /> � � <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C 1 <br /> I <br /> I <br /> 1 20 Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19 <br /> T Printed/Typed Name <br /> Y '1 Signature <br /> Month Day Year <br /> JHS 8022 A(1/0?) I <br /> PA e700-22 -`• 8kt*t GENERATOR SENDS THIS COPY TO DOHS WITHIN 30 DAYS INSTRUCTIONS ON THE BACK <br />;Rev.9-86) Previous editions are obsolete. <br /> To: P.O. Box 40Q Soaamento, CA 95M <br /> IN CASE OF AN EMtEA Y OR,SP11Lr,;PALL 0} <br /> THE NATIONAL RESPOND CENTER 1-80424-8802; WITHIN CALIFORNIA CALL'/-800.862,76050 <br /> ,, <br />