Laserfiche WebLink
Stale of Caliio..ia—Environmental Pr.whon Agency ` - u n I - <br /> form Approved OMB No.2050-0039(Expire,9.30.991 Se:Instrue41onsoD back of pnge b Dep enessal of Toxic Substances Control <br /> Please prim or type. form desiga.d for use on.lire(12Ta rch)ry or. Sacramento,California <br /> UNIFORM HAZARDOUS ^emtor's US EPA ID No. Manifekl Document No. 2. Page 1 Information in the shaded Dram <br /> is not required by Federal law. <br /> WASTE MANIFEST - A '' 1 3 ' 2 7 6 F1 'of ! <br /> 3. Generator's Name and Mailing Address <br /> 5x111 TIiMO PAF''fl`tENS A , <br /> , 291. N. ALF TNF PL'. T ,,_al <br /> k:.."nhi., <br /> 0 <br /> h A. Genemtoh Phone r- ' I - •a <br /> w S. Transporter I Company Name 6. US EPA ID Number <br /> aD 4lP f,,L OILC 11 Li '? H 4 17 2 ", one <br /> car' 7. Transporter 2 Company Name 8. US EPA ID Number <br /> 1'. <br /> Q <br /> V 9. Designgt,,ed Facility Name and Site Address_ 10. US EPA ID Number <br /> Q tl,i�'I1� ' F'llti4 bEh.',Ill I !IL. CO. f lT4 <br /> )z 17.,o s. sn , si . _ ph <br /> _, <br /> 1 .0 iCIS ANGEI.EO. I.ii. .� -1=1 •.c i 9 a 4 .7 : <br /> LL <br /> � 1 12 Co nto nets 13. Tocol Id. U it <br /> �a I1. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) <br /> V No. Ty Quantity Wt/Vol 6i Waste .umber <br /> ,Z 4119'-F'I_PF� Iliiii=tF',LO!_l WriSTF k-::G!Ll':L', ` sX ' <br /> )3 G i0A'rEP S. SI_LIDGE> I s"11 T T .:�:rJ�'J ' !� EPA(CF. f1 <br /> 3N E b <br /> m N sb4 Ny <br /> e - <br /> v R P <br /> v Ac. Safi" <br /> o. T <br /> m O '€PA/Olfiakq . <br /> B r <br /> Z <br /> sZu EPA% <br /> W =6 <br /> LL- <br /> Z ,1 AddmonplWw¢sMomrforvAlotertals 4slAbow Twkh''-' ''k'v .�, .. a '. Wmta:r slti <br /> p SQc <br /> GnAS t ;} <br /> e 4- l+s 1 41 <br /> V &- <br /> Z 15 Special Handl g fintructimn,and Addlhonal lnfarmatian <br /> ^tF{ f OF'+2 [A E F'FL Ei: TI'.-'E ILOfHIIIi; <br /> Z <br /> J 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 /> lel marked,and labeled,and are in all respects i^proper condition for transport by highway according to applicable international and notional government regulations. <br /> J If I am a Iorg quantity generator,I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> o_ practicable and that I have selected the rocieca6le method of treatment,storage,or disposal currently available I.me which minimizes the present and future threat to human health <br /> and the environment;OR, if I a a p quantity g g 4d my g a^ 8 <br /> � mollgenerator,I have made a o faith eNan to minimize waste enaration and select the best waste m a emem method that is <br /> O available to ma and that I can afford. ___!' <br /> y Primed/Typed Name Sig amre ' / Mo^Ih, rpo <br /> J� / ,_per / ryy <br /> Z 1 s- 'k !4/ r i �1 �L~ ,,1,.�j'�i.Il:._'rj' L�yv' L� f '5 <br /> W T 17. Transporter I Acknowledgement of Receipt of Materi Is 1007 <br /> A Printed/Typed Name// - Signomre _ ! Mont Day/ (Yw <br /> w P <br /> O0 18"irons oder 2 Acknowledgement of Receipt of Material. - <br /> IPrinted/Typed Nome - Signature Month Day Year <br /> w T <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Zp _ . ._._.. . .. <br /> — A <br /> C <br /> I 4 <br /> l i <br /> I 20. FacilityOwn or 0 aver'r Certificafion of recei t of hazardous materials covered 6 Ilii ' an' ex bs noted in It..19. <br /> T Printed/Typed Nam _r- Signolure M h /tea Year <br /> Y - L ^� i <br /> DO NOT WRITE BELOW THIS LINE. <br /> i <br /> NDTSC 8022A (z/97) - <br /> PA 8700-22 _ Green TRANSPORTER RETAINS <br />