Laserfiche WebLink
$lateof Cali{er41"�tr-Environmental Protection A ency `�:I <br /> $-3o-99) See Instructions on back of page 6. Department al Toxic subm <br /> .taas Cannot <br /> Form Approved OMB No.4050-00391Expins <br /> Sacramento,Califomio <br /> Photos prlAt ottynpe. Form designed for me on elite(12-pikh)ypewrihc r <br /> t 1. Generolors US EPA fD No. - Manifest Document No. 2. Page 7 Information m the shaded areae <br /> UNIFORM HAZARDOUS n 1 of required by federal law. <br /> WASTE MANIFEST �` U � �� 'i ., Q `1 w C <br /> 3. GenerarorWame and Moiling Address. (, ):;l t <br /> A. StateM-0611DocumentNumber21142580 <br /> _ <br /> �{ B. Shah Generator's ID <br /> c � 4.T.•,•1n•rl (, uA ,�.a3G I <br /> A. Gsnemeye'Phone - <br /> M 5. Treseperter 1 Company Noma 6. US EPA ID Number C. State Trampornr's ID 1 e vert <br /> T <br /> IMkRtt:APi VALLEY WASTE, OIL-11 k. © 0 0 � T f3 7 $ D. Transporter,Phone <br /> 8B. US&A ID NumMr E. Stale Tronsparler's ID l ery .) <br /> 7. Transporter 2 Company Name <br /> e� F..Trpp,par Ge .Phone <br /> a1 US EPA IO Number G. S1.1ii"y' D <br /> V I and Site Add1; <br /> re <br /> ya �`�• �Ct l i 4-�jPP 15 <br /> H. F«iRy's Phone <br /> T .IG'i7'ie1({nL'1 <br /> and ID Number 12. Container. 13. Total 1A. Unit <br /> -1U 11. US DOT Description(including Proper Shipping Name,Hazard Class, ) No Type Ouanfi Wt/Vol I. Waste Number <br /> �Z a. NUN„f2L'RA HAZt1(•$1: 01,),S WA.STI L 1.,iQ010 smte Ry l <br /> t (OILY WAT FH ') t? t;t 4 T T' r- G EPA/ORnr <br /> E <br /> Slate <br /> o N b. <br /> E EPA/Olhe, <br /> v R <br /> .f. .A a. Ston <br /> T <br /> .6 EPA/Other <br /> R <br /> « Saro <br /> d. <br /> i L <br /> EPA/Other <br /> ZJ. .AddilionatDescription.for Material.Listed Above K. Handling Cada for W«tes listed.Above <br /> OXYWATER <br /> A I _ b <br /> N <br /> Its dV IC <br /> r <br /> 4 15. Special Handling Instructions and Additional Information <br /> ILI <br /> eRnl rz�c.Ncr c r<GN! terta• :r-soar SCk�GiU� C� 2 -$�3 8121 <br /> V, - 16. OENERATOR'S CERTIFICATION: thereby deulaeifwt the contenb of this con.iQ mmbnfully and«sur°rely desc•ibed a6wa byp o}4'ar chip indnameand era elaaiFied,packed, <br /> v marked,and labelled,and are in all respects in proper condition for transport by highway according to applicable international and nation°Pgovernment regulations. <br /> -+ <br /> if 1 ons a large quanliq Berumror,I certify that have a pop ram in plum to reduce Ike volume and toxicity of waste generated to the degree I have determined b be economicallyy <br /> pmdiw6la and that I hove selected the Practicable method <br /> yam <br /> storage,or disposal currently mailable to me which minimizes the present and futon threat to human healX <br /> and the environment,OR,if I am a.mo 1 quontiy generator,I have mode a good faith.Hon to minimize my west generation and soled the best waste management method that is <br /> available to me and that I con offered. <br /> } d y e Signature - Menlh Dry Yom <br /> m T 17, Trons rter 1 Acknowled emenl of Recei t of Materials <br /> « <br /> 1 Pridhd/Typed Nome SignaNMonth onth Day Year <br /> ss. 0 I S. Transporter 2 Acknowledemanl of Receipt of Materials <br /> 0 Printed/Typed Name Signature Month Day Year <br /> As <br /> 19. Aierepanry hdloation$pea. <br /> — A <br /> t <br /> 1 <br /> jM. FdeiGl Owner or O color C 'ficaton o rami t of 6axordous maleriah covered 'u ifest exce t a. in Item 19, <br /> T Prin `typed Na/mJs/� Signal ear Month Day Year <br /> DO NOT WRITE pELOW T14 <br /> LINE. <br /> DT5C 8022A(1/99) G"..s TRANSPORTER RETAINS <br /> EPA 8700-22 <br />