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<br />Rpr 01 05 09:58a Kubota Tractor 209-334-9942
<br />State of California -Environmental Protection Agency
<br />Form Approved OMS No, 2050-0039 (Expires 9.30.99) See Instructions on back Age 6.
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<br />Department of Toxic Substances Control
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<br />DTSC 8022A 11/99)
<br />EPA 8700-22 Yellow: GENERATOR RETAINS
<br />UNIFORM HAZARDOUS
<br />1. Generator's US EPA ID No. Manifest Document No.
<br />2. Pogo 1
<br />Information in the shaded areasV
<br />WASTE MANIFEST
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<br />3, Generator's Name and Mailing Address
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<br />A. Generator's Phone i)��""��'r / atYSl
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<br />5. Transporter 1 Compony Nome 6. US EPA ID Number
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<br />1 1. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
<br />12. Containers
<br />13. Total
<br />14. Unit-
<br />No.
<br />Type
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<br />J. Additional Descriptions For,Pylaterials Lisfed,Above
<br />K. FlandiFng Codes'For Wastes Listed Above '
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<br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by propershipping name and are classified, packed,
<br />marked, labeled, in in for highway
<br />and and are all respects proper condition transport by according to applicable international and nation. government regulations.
<br />If ! am a large quantity generator, !certify that I have a program in place to reduce the. volume and toxicity of waste generated to the degree I have determined to be economically
<br />practicable and that 1 have selected the practicable method o treatment, storage, or dijposol currently available to me which minimizes the present and Future threat to human health
<br />and the environment; OR, if 1 am a small quantity generator, I have made a good Faith effort to minimize my waste generation and select the best waste management method that is
<br />available to me and that I can afford. a
<br />Printed/
<br />yped Name p�---'
<br />Sigh4ture '` - ..........•--- - -
<br />MOO Day year -
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<br />17. Transporter 1 Acknowledgement of Receipt of Materials
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<br />.18. Transporter 2 Acknowled emeM of Receipt of Materials
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<br />Printed/Typed Nome
<br />Signature
<br />Month Day Yer
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<br />19. Discrepancy Indication Space
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<br />20. Focili Owner or Operator Certificotion of receipt of hazardous materials covered b this manifest except as noted in Item 19,
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<br />Printed/Typed Name Signature
<br />Month Day Yea-
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<br />DO NOT WRITE BELOW THIS LINE.
<br />DTSC 8022A 11/99)
<br />EPA 8700-22 Yellow: GENERATOR RETAINS
<br />
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