Laserfiche WebLink
hate of California—Environmental Protection Agency <br />..m Approved OMB No. 2050-0039 (Expires 9-30-99) <br />Tease print or type. Form designed for use on elite (12 -pitch) typ <br />a <br />a <br />C <br />u <br />3 <br />3 <br />c <br />C <br />a <br />a <br />c <br />C <br />0 <br />C <br />U <br />F <br />U <br />U <br />k <br />L <br />c <br />c <br />See Instructions on back of page 6 <br />Department of Toxic Substances Control <br />V Sacramento, California <br />DO NUI WNIIC CCLVYY tnw Esse• <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />DTSC 8022A (1/99) produce completed copy of this copy and send to DTSC within 30 days.) <br />EPA 8700-22 <br />1. L ator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />UNIFORM HAZARDOUS <br />is not required by Federal law. <br />WASTE MANIFEST <br />r �j r7 `a <�• ,� 1 ,� r" x� <br />/of <br />3. Generator's Name and Mailing Address <br />A. State Manifest Document Number <br />( [' .. �-• � � '�"' <br />r. r. <br />12'2254286 <br />B. State Generator's ID <br />s f, ✓ <br />� f � <br />r <br />4, Generator's Phone (2_4�) If.7,.7 7' t GSC 7 i�', C�'i' 7' <br />_I I <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID. [Reserved.] <br />5: <br />D. Transporter's Phonen� <br />ly��/� �V7ar QA%I �� r Z <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID [Reserved.] <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br />/4( <br />L c?I�_ T Fe <br />�A) <br />/) oa t / H. Foci ity's Phone <br />7300 (- <br />r Cllr' <br />IV led /`3�f�/fc' �E% GA � 03 �0 / 1 <br />12. Containers 13. Total 14. Unit <br />11. US DOT Description (including Pro,/per Shipping Name, Hazard Class, and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br />t4 -2 o, —. 6 f� q <br />a. � Z . 14/� <br />J� iy <br />State 22-( � / <br />EPA/Other <br />E <br />b <br />State <br />E <br />EPA/Other <br />R <br />I,A <br />State <br />T <br />T <br />a. <br />EPA/Other <br />R <br />state <br />i <br />d. <br />i <br />EPA/Other <br />t <br />1, Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br />b. <br />i <br />� <br />c. d. <br />C <br />15. Special Handling Instructions and Additirgtol Information <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, <br />for transport by highway according to applicable international and nations government regulations. <br />L <br />marked, and labeled, and are in all respects in proper condition <br />J <br />If I am a large quantity generator, I 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 />and that I have selected the �racticoble method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />and select the best waste management method that is <br />n <br />practicable <br />and the environment; OR, if I am a small quantity generator, I have made a good Faith effort t minimize my waste generation <br />r <br />available to me and that I can afford. <br />Month Day Year <br />Signature <br />Printe /Typed Nae <br />u <br />Y <br />T <br />p <br />A <br />17. Trans orter 1 Acknowled ement of Receipt of Materials _ - <br />Mlea <br />onth Day Si nature <br />Prin Typed _ g ...-:: -" .� C r-•.. r /% /' i <br />Ted Na / y IJ r �i L1 <br />l <br />.05/� <br />t j <br />i �x'7/r <br />L <br />018. <br />Transporter 2 Acknowledement of Receipt of Materials Month Day Year <br />Signature <br />R <br />Printed/Typed Name <br />+� <br />E <br />,n <br />U <br />p <br />19. Discrepancylndication Space <br />Z <br />— <br />F <br />A <br />C <br />20. Facili Owner or Operator Certification of receipt of hazardous materials covered b this an est exce t. s n sed in Item 19. <br />Month Day Year -• <br />j <br />Signature <br />Printed/TypedH*ime <br />DO NUI WNIIC CCLVYY tnw Esse• <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />DTSC 8022A (1/99) produce completed copy of this copy and send to DTSC within 30 days.) <br />EPA 8700-22 <br />