Laserfiche WebLink
S}ote'of California—Environmentol Protection Agency in back of�Oe 6. De artment of Toxic Substances Control <br /> Forni Approved OMB No.2050-0039[Expires 9-30-99[ S@@ InStCUCt10nS OP <br /> Please print or type. Form designed for use on elite(12-pitch)typewriter. Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No, 2. Page I Information in the shaded areas <br /> UNIFORM HAZARDOUSis not required by Federal law. <br /> WASTE MANIFEST 9 ? 5 1 1 17 ) f � 1 of <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number 24699718 <br /> 4545 40TA8 LAH8 B. State Generator's ID <br /> in 0 4TflCI[`ff3N r CA 95215 <br /> LO 4. Generators Phone I 9$9 983-1938 1�.0#1.tflCt: 0119,LN HUNTER <br /> h C. State Transporter's ID[Reserved.] <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number P <br /> a' Rl)I1CH�TII{(1NK�s1'fA% Tiltf;li, I] 1 3 4 5 7 7 D. Transporter'sPhoneL�}A}324 119311 <br /> 6 <br /> 0 la <br /> C9 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved,] <br /> F. Transporter's Phone _ <br /> ...0 9. Designated Facility Name and Site Address 10, US EPA ID Number G. Stale Facility's ID <br /> Z 61 51 11 <br /> Z VAIC 901:PORNKHTAI. H. Facility's Phone <br /> 2881 BAY ROAD '� � <br /> .t° 9AST PALO ALTO f'A 94113 <br /> 12. Containers i3. Total 14. Unit <br /> f V <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) Na Type Quantity Wt/vol I. Waste Number <br /> Z a, 1] 11A I;A�.A'.� 1Iti1 HASTE LI UIa State <br /> {I21OPROPYL AI>A0L,AXM0NhI19 MUM) � EPA/Other <br /> 3 G PrOl 2 202551 i �l <br /> ob. 1-hA AKMTOC T State <br /> IS? <br /> EPA/Other E 11110 <br /> R Pt ' 019741 <br /> RC <br /> C%4 <br /> A c State <br /> o T <br /> w O EPA/Other <br /> R <br /> 1X d state <br /> Z EPA/Other <br /> uj <br /> Lu <br /> K, Handling Codes for Wastes Listed Above <br /> to J. Additional Descriptions For Materials Listed Above <br /> Z / a_ 6. ' <br /> Crr7s i' 7' .1 c. d. <br /> Q <br /> Z15. Special Noodling Instructions and Additional Information A HR. SMSKINCY ALSPOI#5S 1: j289)983-193# <br /> 0 <br /> H <br /> Q <br /> Z <br /> Lu <br /> u <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 /> Vmarked,and labeled,and are in all respects in proper condition for transport 6y highway according to opp4ieo61e international and national government regulations. <br /> I#l am o large quontiy 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 economical)y <br /> a practicable and that I have selected rhe rocticable method of treatment,storage,or disposal currently available to ma which minimizes the present and future threat to fuman health <br /> o p <br /> and the environment;OR,if I am a small quantity generator,I have made o good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> 0 / Month Day Year <br /> Signature,, C <br /> PrintedfTypedlame f r ' y <br /> Z -� <br /> w T 17. Transporter 1 Acknowledgement of Receipt of Materials 1 <br /> ad p Printed/Typed Name ,.-- Signature-" Month Dap Year <br /> !} t ! <br /> Lu S <br /> r' , «..'� .-.�. .�•f..a•^Yom.."s".. k.J `i <br /> Lu <br /> us P - <br /> B 1 S. Transporter 2 Acknowled ement of Receipt of Materials - Month Day Year <br /> 0 T Printed/Typed Name Signature <br /> su E <br /> v) R <br /> V19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> 1 <br /> L <br /> f 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. _T —Month Day Year <br /> T Printed/Typed Name Signature <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 822(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />