Laserfiche WebLink
$mane of Cofilomai Enmmmxemal Protection Ageney <br /> Fon,Appm.ed OMB Na.2050-0039(Expires 9-36961 '�r See Instructions on back Of a 6.C _ .peponmem of Toxk Substomn Comrc <br /> _%eosc print or type. Form designed for sew en euro(12,uch)ry�riter. i s `s em seemerema,Califoma <br /> 1. Ge^ermoi s US EPA ID No. Manifest Document No. 2. Page 1 Informmim in the shaded areas <br /> UNIFORM HAZARDOUS _ is not required by Federal law. <br /> -WASTE MANIFEST �} L c �; [7111`7 � Cwt 1 3 �, of <br /> 3. Generator's Ngme and Mailing Address A. State Manifest Document Number <br /> DEWS7 1 <br /> 3L�St EL�r4ao51.. Gu> A <br /> n 5�[K T-Cl✓ r c.-A A I q S 203 a. State Genre se.ID <br /> " A. Ge^erata:s Pha^e (2M) 46 2-[)-6'Z <br /> m <br /> O 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter'.ID �J <br /> C , d c 9 q! 6 E 3 r L D. Tran.porter's Phone SIo-237-13 3 <br /> Q7. Transporter 2 Company Name 8. US EPA ID Number E. Stale Transporter',ID <br /> V <br /> F. Transpaner's Ph. <br /> Q <br /> Z 9. Designated Facility Name and$ice Address 10. US EPA ID Numbs G. Stale Faciliy's ID <br /> i o EriGson,Inc. G 1010 <br /> Cjy 6 g 2 <br /> 255 Parr Blvd. H. Facility's Phage <br /> Ri_u� :nc.T,C?. :.::a4c' - 6 n n 9 4 5 6 3 ,) ' (5101235-1393 <br /> . 1 <br /> i V Containers Tonal 14. Unit <br /> Z 11. US DOT Description(uscludirq Proper Shipping Nome.Hazard ClN ouoss,and ID Number) No. T Quantity Wt/Vol 1. Wase Number <br /> \I tx- <br /> 3 M:,N-R(RA Hazardous Wa:vte Solid <br /> EP <br /> 17 o E Waste. En ptv StorarTe Tank. .1,1/ T IP 'j- 5,01 P <br /> m N b. Sha e <br /> R _ EPA/OH. <br /> m T sate <br /> O <br /> W R EPA/odtm <br /> z state <br /> W d. <br /> U EPA/Other <br /> w <br /> Z <br /> Z <br /> J. Additional Descriptions for Materials listed Above / K Handling Codes for Wastes Listed Above <br /> w Qtv•�El npty Storage Tank(s)# . 4�? , ! b' <br /> .Tank(s) have teen inerted with 15 <br /> lbs.Dry Ice Per 1000 Gallon Capacity. t d. <br /> z <br /> 15. Special Handling Instructions and Additional Information <br /> iKeep away from sources of ignition./ w�Al"w�a"v�s wear hardhats when working around <br /> w <br /> U.G.S.T. 's 24 H7 . Contact Nam_:Ye y� *LtL Phone :!fY <br /> x <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping come and are classified, <br /> Q packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national govamment regulafiau. <br /> U <br /> If I am a large quantity gm icrar, I certify that I have o program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> Q_ economically practicable and that I have selected the practicable method of treatment, storage,or disposal currently available is, me which minimim the present and fuNn <br /> W threat to human hmhh and the mrimnarent; OR, R 1 am a small quantity generator, I have made a good faith effort to minimize my ware generation and select the best <br /> C waste numusfiament method that is avaaable to me and that I can afford. <br /> U Primed/Typed Name IS' 'alu' Month Day Year <br /> 'u /Jti/ /J /�r " �! <br /> Z T 17. tracuporter 1 Acknowkd einem of Receipt of Materials <br /> LAI R <br /> Kd <br /> N Printed/TypeName Sign - A1mth Day Yens <br /> w S <br /> P <br /> w O 1 tans 2 Acknowledgement o4 Receipt of Materials , <br /> LL T Prinsed/Typed Name Signature Month Day Year <br /> Q E <br /> It <br /> yWj 19. Discrepoetcy Indication Space <br /> Q F <br /> U A <br /> Z C <br /> I <br /> L <br /> t 20. Facil' Owner lir O crater Certification of receipt of hazardous materials cewred b this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> /-)TV c D 547-0 517__(�, C `t Z <br /> DO NOT WRITE BELOW THIS UNE. <br /> OTSC 8022A (9/9A) .V`! I'0 i1TSC WITHI- 20 <br /> EPA 8700-22 <br />