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State of Colifomio—Enviranmemal Protection Agency <br /> For,-A proved OMB No.2050-0039(Expires 9-30 96) See Instructions on baC 9e 6• Department of Toxic Substances Control <br /> i Moaxe rim or type. Form designed for use on elite(72p ewrftr. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br /> is rat required by Federal km. <br /> ► WASTE MANIFEST of <br /> 3. Generator's Name and Mailing Address <br /> } C4 a •) s 41PIl � S 7-a Ac sJ SL � <br /> } <br /> O 5.1rasporter 1 Company Nana 6. US EPA ID Number <br /> 4 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> CO U . <br /> Z 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> o Ecology Control Industries <br /> 255 Parr Blvd. <br /> U Richmond, CA 94801 C <br /> A I DI 00 1914 16160 1912 <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> No. T Quantity Wt/Vol <br /> 3 _a / / <br /> 00 <br /> CO <br /> CO N b. <br /> E <br /> v <br /> C4 R <br /> A <br /> go T C. <br /> O <br /> tY R <br /> U <br /> Z d. <br /> LU <br /> V <br /> U.1 <br /> V) <br /> Z <br /> O <br /> CL <br /> N <br /> U.1 <br /> Q <br /> Z. <br /> ® 15. Special Handling Instructions and Additional Inforrnation <br /> P <br /> Lu f e,11 J 6'"09,0?0L'/'-J'0 05725 ; � 1� . Goan'l'fC'7 <br /> 16. GEN TorIFICATION: I hereby declare that the caNems of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> Upacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> - If I am a large quantity generator, 1 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 <br /> iL economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> N threat to human health and the environment;OR,if I am a small quantify generator,I have made a good faith effort to minimize my waste generation and select the best <br /> p� waste method that is available to me and that I can afford. <br /> O Printed Name �1Z fir- / �/ Signature Printed/typed �✓ fT Cl"et) g {� Month Day Year <br /> <� <br /> 44 <br /> LUR 17. Transporter 1 Acknowledgement of Receiptof Materials <br /> 0 A Printed/Typed Name r Signature r Month Day Year <br /> 'Lug r <br /> w 0 18. Transporter 2 Acknowledgement of Receipt of Materials k <br /> u. T Printed/Typed Name Signature/ / Month Day Year s <br /> O E <br /> V) 19. Discrepancy Indication Space <br /> U F <br /> A <br /> Z c <br /> I <br /> L <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 <br /> Y <br /> DO NOT WRITE BELOW THIS UNE. <br /> DTSC 8022A (1/95) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />