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' _- .� ,�+. Deportment of Health SeMces
<br />{ _ �omio•-Heofth and..Weuom A9oncy s, See Instructions oil . g8 6• Toxic`Substaxes CoMol Program
<br /> ;�:r:' E Socramanto.Ca9fortra
<br /> r. e or type. ]'arra daso-d fa Imo on one(12•P%vfpewrtter} t �
<br /> 1.Generatofs US EP lD,e�a u f hAorrf 2 Pace 1 Intomialion In the s7roded areas
<br /> UNIFORM HAZARDOUS �+ U U a 23 �f vlC� 7 t� ��, — is not reaukedoyreeerataw
<br /> WASTE MANIFEST I ! I I I. I 1 I I I I I �- , Tl+urnb�
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<br /> -' 1& GENERATOR-5 CEiR11TCATIOW I hereby.deckxe that the contents of this cord9nm*nt are fW and accutarey dosenCed Wenx lwx d ands rralbnd 9--rd re90afkxn..
<br /> (A.m. h r oordRbn for transport by hlptsway accordhg oPP
<br /> r Z packed.marked.and kabeled,and are In pects Props.
<br /> •i::':.,: Q h o'to reduce the votlme and toxielly of waste generated to It*degree I have detemr a d to be
<br /> ;1;r ?t 1 am a Im9e quantRy 4enerator..l cedlfy that I have a Program plot n*'Wrdm the
<br /> Q econors>raM Proctkrot�e and that f trove selected the proctkable method of tmatment.storage.or disposal currently woilabie to�egenhendlon and sobat that best wale
<br /> :' tMecd to rwnwr+hedFh and Mo envkorxnerd:OR.r I om o unol Quantay generator.l have made a good follh e(iorf to mkdmlae rrry
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<br /> �' Z0 FocRtY Owner or Operator CedKkatlon of receipt of hazardora moterlds covered by thh rnarillest except os noted b Rem 19. MorMh f)OYd_:'. Yea
<br /> • I Printed f typed Name
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<br /> DO'NOT WRITE BELOW THIS LINE.
<br /> E glue: GENERATOR SENDS IM COPYTO DHSW"30 DAY
<br /> P.O.Box 400.Sacramento.CA 95812100
<br /> 01S 8022A(]2/90) To:
<br /> i' EPA 87022
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