Laserfiche WebLink
_ StateofCallfornia--Healthand Welfare Agency <br /> F Department of Health Services <br /> ( ' ur so print or tOMR;No.�50-0039(Expires 930 91) RUC !a Ti (' r1 Toxic Substances Control Division <br /> P:e ae type.' (Form designed for use on elite(1212 Bch typewriter). C'.U L at 1 Sacramento,California <br /> ' ( UNIFORM HAZARDOUS ratar's US EPA4�1 Manifest age I <br /> .�4 WASTE MANIFEST ' 4 ument No. Information in the shaded areas <br /> n . o �f rA . ! t reguiretl by Federal law.erator's Name and Mailing Address nifest Document Number <br /> ASCO DELTA 705 NORTH CARLTON AVENUE 8STOCKTON, CALIFORNIA 95203 nerstara ID <br /> 4. Generator's Phone( 209 9.41-4111 rl _ <br /> 1 nI il 71 n 5. Transporter 1 Company Name 8. US EPA ID Number C. State Trollop er'a ID ' (1 <br /> N CT..NSICAL WASTE .IAIQAGEMENT CAD 0 013 91816171118 D. Transporter'.Phone jJ <br /> m 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> 1' 1 1 1 1 1 1 F. Transporter's Phone <br /> Q <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> J CH=-1ICAL WASTE MANAGEMENT <br /> J <br /> 117 0 35251 OLD SKYLINE ROAD H. Facility a PDoneqtT <br /> LO KETTLEMA�7 CITY, CA 93239 T 4 7 <br /> O 12. Containers 13. Total 14. I. <br /> !'1 w 11. US DOT Description(Including Proper Shipping Neme,Hazard Class.and 10 Number) Ouantity Unit Waste No. <br /> r—( No. Type Wt/Vol <br /> ,Lr v e. WAST3 FLAMABLE LIQUID, N.O.S. FLANABLE State <br /> 9 G LIQ UID UM 1993 (F005) z Ib s 461 <br /> 1.. E 3 EPA/Other <br /> 3 E b 01 rj rlIrl G F005 <br /> iv R HAZARDOUS W TE SOLID, N.O.S. ORME State <br /> T NA91S9 (CRUSH3D EZSLPTY CONTAINERS LESS THAN 30 EPA 1 <br /> O 3 <br /> N <br /> a R c. <br /> o / grate <br /> 0 <br /> CP <br /> EPA/Other <br /> Iw- d' State <br /> Z <br /> W <br /> U <br /> EPA/Other <br /> w <br /> W J. Additional Deacd <br /> Z phone for Materiel!Listed Above K. Handling Codes for Wastes Listed Above <br /> a A PROFILE # E02623SPO a. b <br /> N <br /> ¢ B PROFILE # G16634SF0 � 03 C. d. <br /> Zz <br /> 0 <br /> Q15. Special Handling Instructions and Additional Information <br /> Z <br /> W FJ. <br /> l <br /> J <br /> a te. <br /> U <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> J and are classified,packed,marked.and labeled,and are in all respects in proper condition for transport by highway according to applicable intemational and <br /> ynational government regulations. <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 <br /> p to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> } present and future threat to human health and the environment:OR,if I am a small Quantity generator,I have made a good faith effort to minimize my waste <br /> 0 generation and select the best waste management method that is available to me and that 1 can afford. <br /> Z <br /> Printed/Typed Name Signature Month Day Year <br /> ¢ A , � <br /> W T 17. Transporter 1 Acknowledgement of Receipt of Materiels <br /> ZR <br /> Q N Printed/Typed Names Signature Month Day Year <br /> o s .moi C--� <br /> w 0 18. Transporter 2 Acknowledgement of Receipt of Materials ' <br /> N <br /> T Printed/Typatl Name Signature Month Day Year <br /> E <br /> 2 " <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> L <br /> I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this menaeat except ea noted in Item 19. <br /> T <br /> y Printed/Typed Name Slgnsh. ♦ onM Day ear <br /> DHS 8722 A(1/88) <br /> EPA 8700-22 Do Not Write Below This Line <br /> - - <br /> (Rev.9-88)Previous editions are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />