Laserfiche WebLink
0 <br />ID <br />V) <br />04 <br />9) <br />_j <br />cc <br />0 <br />LLQ <br />t <br />3: <br />CV <br />0 <br />OD <br />op <br />1W <br />CY <br />aD <br />corm Approvea umb fto. [U3akj=xp4res 9-j0-88) a oxic Substances I-ontrof Diviston <br />-1- — — , 1— __ ­.- — Sacramento. California <br />DHS 8022 A ?/ 87)" <br />30 DS INSTRUCTIONSON THE BACK feH14 Ai' <br />EPA 8700-22 \,-J ' Yellow 'TSgF SENDS THISQem, "ATOR <br />(Rev. 9-86) Previous editions are obsolete. <br />A <br />is <br />UNIFORM HAZARDOU SM&I 1. Generator's L I rq fPA IQ No. Mani2. Page 1 Information in the shaded areas <br />Docum I <br />of is not required by Federal law. <br />WASTE MANIFEST I a 11. A <br />3. Generator's Name and Mailing Address A. State,0anifesit Documentll4nib <br />Santa Fe Railvay Co, 8 7 2,4" <br />Diamond & E. Worth St. B. State Generator's ID <br />4.eGAMAWA, (CA ) 95205 (213) 267--3454 <br />5. Transporter I Company Name 6. US EPA ID Number C. State-T—ransporter's-ID <br />XfjC_ I C1 (N (312 1!116 (01.319 D. Ti -1123 <br />7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br />9. Designated Facility Name and it; Address 10. US EPA ID Number G.ti.�i�ta'fNcflity'a ID <br />Chemical WAsteMomagement, I <br />35251 Old SkYlift,_ Blvd. <br />Kettleman City,,a-- 93239 Q JAJT101919161� <br />12. Containers <br />13. Total <br />14. <br />1. - <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />Quantity <br />Unit <br />Waste No. <br />No. Type <br />Wt/Vol <br />a. Waste Oil Contaminated Debris <br />State <br />0) 1 <br />G <br />E <br />CaliforfAa Regulated Waste On�ir <br />01 <br />N <br />E <br />b. 4 <br />to <br />R <br />"A <br />A <br />/Otito <br />T <br />0 <br />R <br />C. <br />EPA/Other <br />d. 4. <br />State <br />-EPA/Other <br />J. Addiflimal Des'cripfions for Materials Ljsted Above <br />K Wdk%V a for Wastea I fated Above <br />Bunker Oil COUtAIII1111"ted I <br />To <br />X <br />15. Special Handling Instructions and Ad M6ditionall or tion <br />IV, <br />Gloves, safety glasees <br />16. <br />GENERATOR'S CERTIFICATION: lherqbydeclare thI the contents of this consignment are fully and accurately described above by proper shipping <br />name and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable <br />international and national government regulatfons.) <br />If I am a large quantity generator, I certify th . bt-rhave a program in place to reduce the volume and toxicity of waste generated to the degree I have <br />determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to <br />me which minimizes the present and future threat to human health and the environment; OR, if I am a small quantity generator, I have made a good <br />faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. <br />Printed /Typed Na a <br />Signature Month Day Year <br />T <br />R <br />17. Transporter 1 Acknowledgement of Recut o f Materials <br />A <br />N <br />Printed/T d Name i6natur Month Day Y <br />Vir A, <br />S <br />I <br />P <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of -Materials <br />R <br />T <br />Printed/Typed Name <br />Signatur Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />20. Facility Owner o - r Operator Certification ofdoipt of hazardous materials co fed by this manifest except as noted in item 19. <br />T <br />y <br />Prtnted/Typed Name,: <br />Sign ure Month Day�Year <br />4�e, <br />" , a <br />DHS 8022 A ?/ 87)" <br />30 DS INSTRUCTIONSON THE BACK feH14 Ai' <br />EPA 8700-22 \,-J ' Yellow 'TSgF SENDS THISQem, "ATOR <br />(Rev. 9-86) Previous editions are obsolete. <br />A <br />is <br />