Laserfiche WebLink
(Expires 9C 0- J See Instructions on back of page 6. De Nemn of Toxic Subrmscm Cont, <br /> Approved OMB No. d sig.d or ur9J694) F 8 P° <br /> v ,se price ar type. Form desiprwd ror ase on elib(139itc6 Ago Sacramento,California <br /> rotor's U$EPA ID No. Manifest Document 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS rwt required by Federal law. <br /> WASTE MANIFEST n �n of <br /> 3. Geswrator's Name and Mailing Address A:State Manifest Doasrnenf Nunsber}t „P <br /> Sky FT Tiz A n S a= -T+�T,o �t'-T— 1L <br /> n 1 G I S w 1 F T w �'1 y ) S T C. C k 1 %fV G 56tiStalaGexruiatf lD M» - s:"i t �t,���. <br /> s'n A. Generator,Phone (Z, !' C WIN tg `td x?rt' <br /> w <br /> 6 5. Transporter 1 Company Name 6. US EPA ID Number 'C:zS �Rmm{rii t'z'YD <br /> og -xTra Poherf y ' <br /> o <br /> ra2 Company Name US EPA ID Number 'E..S}afe Tmrisporle7t ^'F s ' '' id.. <br /> .._ . ._. -... -.. c.:. <br /> _Q nsporter ..ems r <br /> V .. Fv,Tronspode.v Phoh.R$s t',r TW. W <br /> �3%jL <br /> v.*rtxce '�����i- x s <br /> Q 9. Designated Facility Name and Site Address 10. US EPA ID Number G-"Stwe aar6�5ylDvs v1+':s>4 u s r KX <br /> (Co CHEna1LALtvAStil�AnaSE�`I� n�T S ^� C ; <br /> L DS k y L 1 N I-; h' D Faar�fYhoeeK Fa A# <br /> C) < 0 . <br /> V 12. Container 13. Total 14. Unit � <br /> 00Z 11. US DOT Description(Including Proper Shipping Nome,Hazard Class,and ID Number) No Type Quantity Wi/VolRs ERE VM hv, . <br /> T-,4EEa. Sit.. ..,,- 'Ta,. <br /> cv� Nord RG2A HA AP- ouS <br /> dr) E <br /> 3 ( tp T C LI rl S X ' <br /> C E - <br /> 4` <br /> N R z��ONiet" <br /> d A <br /> mT C. t5tab'- <br /> 0 <br /> IY R a 's <br /> Z <br /> .Z �d dtnrwl.Deuapdora(orMalenalc lssfed,Abow .� ,,r s'" ;� a' Handlrog ades,for?4yasfes luted <br /> �d 4 *' h', s S o i, ay •z�` y fi 'li6y'� <br /> 0 <br /> Q 15. Special Handling Instructions and Additional Information <br /> Z r c F I l e $ P NI (r <br /> J <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the canter%of the consignment are fully and accurately deuribad above by proper shipping name and are c ossified, <br /> Q pocked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,stale and irrhimotional laws. <br /> U <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 <br /> economically practicable and that I have selected the practicable meM:dl of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> y threat to human health and the environments OR,if I am a small qua,.rity ganeret°r, I have made a nod faith effort to minimize my waste generation and select the best <br /> W waste management method that is available to me and that I can afford. <br /> Q Printed/Typed Nome Sig re .._-- Month Day Year <br /> lilt17 1/21 `L4 <br /> WT V. Trans <br /> icer 1 Acknowled emmt of Receipt of Materials f <br /> R <br /> Vr A Printed/Typed Nome $ignabre t onth Day S <br /> N V <br /> W t <br /> 0 18. Trans rer 2 Acknowledgement of Receipt of Material <br /> W <br /> T Printed/Typed Name Sigrwlure Month Day Year <br /> LL <br /> O R <br /> W 19. Discrepancy Indication Space <br /> N <br /> U F <br /> A <br /> Z C <br /> I <br /> L <br /> I 20. Facili Owner or rotor Certification of receipt of hazardous materials covered b this manifest except^as entad in Ilam 19. <br /> T Printed/Typed Name SigmNre- ' 1 Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> c 'Yellow!'-- TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> 22A (12/91) 3&'�i /h-'1 1 _--- v } (Gerseraton who submit hazardous waste for transport out -stole, <br /> DISC 80 <br /> - <br /> ,'EPA 88022A l / l produce completedcopy of this copy and send to DTSC within 30 days.) <br />