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.)mics--Environmental Protection Agency t <br /> ved OMB No.2050-0039(Expires 9 30.94) ( See Instructions On back s.*,,oge 6. Department of Toxic.Substances.Contro: <br /> t or type. -'Form designed for use'owelite(12•pitch)-i pre-Mer. Sacrdmento,CcGfomic <br /> 1.'Generators US-EPA ID No. ':.- Manifest Dow terM.No. 2. Page 1 Information in the shaded areas- <br /> UNIFORM : <br /> :HAZARDOUS. x y .., j . <br /> j .b <br /> is not required by federal law _ <br /> I'll 15 1 <br /> WASTE MANIFEST. <br /> of <br /> rators Na d Mailing Addre ,rte, p <br /> AO <br /> uf: Geneiafors:Phons. <br /> tj 5 Transporter 1 Company Name .,. .bpt1S'EPA.ID Number.'` 'f:•t,' _: :> <br /> y�tp y r 4 r 'y41w+.a... A,�y:'�1f•i,:,-` w ,1 '`-` <br /> ++—j -7. Tranaporter2 Comporgr,Nams c8.':US EPA ID Number' <br /> Q 9: gnated Fadi Name nit She A res 10. US EPA ID Number <br /> 3;5 MMC?lM V o H Cft Yr <br /> 12. Co <br /> 13. Total 14. Unit• <br /> 11. US DOT; meluding,Oroporrshippinjf.14 ,'14=rd Cla ;.and D Nu r) ntainer.. <br /> ? I No. T Quantity wt/vol <br /> SC ; t••+ tom. f' _ - <br /> 3 G � <br /> � -r..�.�..•.. ..3i r. :-s.eea. � •••�•�i.ri�GR!s-���.�+�.•-a � i Q <br /> E b. <br /> .� T C. <br /> �OA) 1. <br /> 'Z d. <br /> LU <br /> in <br /> � i td6ftittcNon � ,y. ,.1k. . .:.° ,.•.� �, ,,� <br /> ,hi <br /> 7.7 <br /> 16 GENERATOR'S,CEIMRCATION: I hereliydeciare that'the contents of this consignment are fullyand accurately described above by proper shipping name and'are'classified <br /> ed,marked;and labeled,and'are•in all respects in proper condition for transport b + i <br /> y highvroypecording to applicable international and national.gavemment iegulahons r . . <br /> G <br /> :a large quantity generator l'certi(y+lhat 1 have a Program in pksce.to roduee'the vaWtne isnd toxicityof'waste generated-to'the-degree-1•havq determined toybeV <br /> +�= t� sYotw'nicaliy preeticobb.and that I have selected the-procticoble method of'lreahnertt,storage or disposal•eurrently available tome which:rrrimntiies..the preserrt'and fuhne Y` <br /> fhieat'to human heahh.andiths enviionmeM;;OR,:ff.l am o smalltquonitly generatar-I'h inade'a 0oa.effort minimize my wastegeneration.-and:iekcf the besf't+`� <br /> tN <br /> �ovcilable forme and that i can afford $ ' <br /> Pn Yped <br /> farm <br /> ...,tsiv <br /> rd <br /> Z. R 17. Transporter 1 AcknavA of Receipt Materials *•r. <br /> LU Printed/Typed Name <br /> Signature :. �a <br /> Month <br /> :O 18. Tronsoorter 2 Acknowledgement of Receipt of Materials <br /> to <br /> '• '.RPned/Typed'NameT <br /> .. :: <br /> 'R Signature MonNt *^ Day.,-t,.•. <br /> u t 19:.Discrepancy Indication Space. ,• <br /> ••K <br /> d <br /> is •E'1 <br /> ::c•� L. r - ' ;fir �:iF;:. :'. <br /> +' s p;; '20.-Facility Oviner ocrator•Certificctfon of.recei t.of hazardous materiA.-covered -9kis:•manifestex6Was noted in Item-19. <br /> Y' Printed%Typed Name.�l� >t y Signolure�r'F "- .>f. Id. -.y,,��s. ''r. ':i.' -._ -, MOMh; Day Yadr'3TrS t�`•'I <br /> DO'.NOT WRITE BELO' <br /> orsc 8022A (9/93) � i �- ;! . •.. . �.,-..-.•� <br /> EPA 8700-22 tr �` s Greent• TRANSPORTER RETAINS j <br />