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<br /> Foanjlpprov fit OMB No.2050-0039(Expires 9-30 88) 'F` Toxic Substances Control Division
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<br /> Please Drint Forth designed for use on elite(tom. ewriteq.� "'� � ` - +�•�� - 'Sacramento.California
<br /> UNIFORM HAZARDOUS: 1 Gen2wr6r's US EPA ID No. s«{t t _Manifest � 4e'9; ,j d{armatlon;in_the'§haded areas
<br /> WASTE MAPIIFEST1.4 Icl 01111 101 -7 - r Document No. sus._ a$ w
<br /> (ve`�,lS.Fiequir-! ^ Federal law.. ,r
<br /> 3. Generator's Name and Mailing Address A tState,Mam{est Document�Numbar.+' +�
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<br /> 5/S G 7 EM��P�P/S s T'� �i e�,a,uT=C�.o `�S/S" B rState Generator's 1D
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<br /> 4. Generator's Phone(i/��' _ fb S,r ,Yf reg + < 4 »?V?::
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<br /><� 5. Transporter 1 Company Name 6. US EPAAD Number C:State,T anspoRer's IDw
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<br /> 7 Transporter 2 any Name 8 US EPA'ID Number EwStat wnsportera ID
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<br /> 9 Designated Facafy Name and Site Addressry� f to. US EP D Number rj GJS.State-1Ae
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<br /> G15_Special Handling Instrudrorn and Additional Information zz1 r: .F1�lt y~ 617C.-. ter• rrk�. + r _ t
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<br /> O {.GENERATOR'S CERWICATION. I herebyde'clare.that the.contents'of thi consignment are''ully and accurately described above by proper shipping
<br /> name and are classified,packed,marked and labeled and are in all respects in proper condition for transport by highway according to applicable
<br /> J ` international and national government regulations
<br /> -H I am s large quantity generator;L certify that J have a program in place tS reduce the volume and toziaty of.waste generated to the degree I have
<br /> determined to be economically practicable and that 1'have selected the-."cticable iriiethod�af treatment;,strage,or disposal currently.available to
<br /> _ me which.minimizes the present-and future threat:to health and th environment;;OR, f,.l am' small quantity generator,1 have made a.good
<br />} ^faith effort to minimize my waste generation and select the best waste ma m nt-method that is available to me and that I can afford.
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<br /> W T 1 r nsporter 1 Acknowledgement of Receipt 6f Materials y .
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<br /> A Printed/Typed Nano Signet ��..•.i Month Day Year
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<br /> WQ'18. Transporter 2 Aeknowied t of Receipt of Materials
<br /> < T Printed/Typed Name Signature 3-; Month Day Year
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<br /> 19. Discrepancy Indication Space
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<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 Signature; Month Day Year
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<br /> DHS 8022 A(1/87) Blue: GENERATOR SENDS THIS COPY TO DOHS WITHIN 30 DAYS INSTRUCTIONS ON THE BACK
<br /> EPA 8700-22 i 1
<br /> (Rev.9-88) Previous editions are obsolete. To: P.O. Box 400, Sacramento, CA 95802 it
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