Laserfiche WebLink
' ronmental Protection Apemy -''� <br /> OMB No.2050-0039(Ezpim'93094) , See Instructions On back oe2 b. Department of Toxic Substonm Contr <br /> print or type. Form designed for use an elite(12-pitch)typewriter. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded.,.as <br /> is w required by Federal law. <br /> WASTE MANIFEST <br /> of 1 <br /> 3. Generator's Name and Mailing Address A _State Manifest Document Number "' u <br /> o l+�r< 7" /�.vS�eTATiod - � r91803 <br /> LO <br /> u74a/ �� `'�Ay�yja/ Me GemratorY lD c .Y�✓ <br /> �t3en6aIT� _ ✓� GO �.S <br /> 4. r or,s P one �� z'nA+}iJ tFy: a Pyi9 <br /> C5. Transporter 1 Company Name 6. US EPA ID Number Tarsgsdrta.fslD;, <br /> aswwt. <br /> 7. Transporter 2 Company Nome 8. US EPA ID Number :'EYrSlwe TsorapWer'yD %r. <br /> frmsport¢r'S?Pb-- -� a <br /> aced Fo il' Name ,ndd Site U Number G:'".Sta�eF TilytlDD �u xr3�$4 <br /> C]a E� /B� L�O X2 yM b <br /> Z D�i <br /> 000 525/ <br /> E77XFinIV 04 7Y,Clq j,32s <br /> M V Containers 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 72. �r + , <br /> Z No. I Type Quantity Wt/Vol n oon. 6e s <br /> G /✓o��.e�A N�zAA�Dvds SAS%C <br /> epi E <br /> m E 6. ta(e t i <br /> C. <br /> Cis 0 <br /> Cd <br /> -R <br /> r d_U fp <br /> Lu <br /> N �Lt <br /> Z d. 1 '.for Matenals:Gnied <br /> 0 .k � }+T? ;� T f f N ft W� ,11. �°-iy •S�y{yv'. <br /> St <br /> Z S .wtv'k P:!i• � 'Ri. a m.. :e.SQL ! ...'f,— '*.e .i_. t-v .. .... a-f _� *4t .. a,. .i <br /> 15 Special Handling Instructions and Additional Information ' /gIDZS —��✓Yo y ... <br /> 2 <br /> t <br /> 16. GENERATOR'S CERTIFICATION: I hereby decl re that the Antents of this consignment are fully and accurately described a ve by proper shipping name and arc classified, <br /> s <. packed,marked,and labeled,and ore in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <br /> V <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 method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> threat to human health and the environment;OR,if I am a small quantity wor, I have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. <br /> !Y P'fd/Typed Name Sig sure Doy ar <br /> U twq�/ :a _ i <br /> Z e 17. Trans rte,1 Acknowle ement of Recei 1 of Materials / <br /> Wor <br /> i� N Prime m< ^� S' re Month <br /> W S <br /> W P <br /> 0 <br /> W 18. Trans orter 2 Acknowled ¢m¢nt of ecei t o1 Materiah <br /> W T Printed/Typed Name Signature _ - Monts Day Year <br /> LL E ... <br /> O e <br /> W 19. Discrepancy Indication Space <br /> n <br /> F <br /> U <br /> U A <br /> 'Z . I <br /> L <br /> 20. Focili Owner or Orwor Cerfificotion of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T ted/Typed Name a Month Day Year <br /> Y <br /> DO NOT WRITE BELOWkTSS LINE. <br /> "Yellow: TSDF-SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC'8022A (9/93) "" - (Generators who submit hazardous waste for transport outofatate, <br /> EPA 8700--22 - .. produce completed copy of this copy and send to DTSC within 30 days.)' <br />