Laserfiche WebLink
State of CaRfomla—En4r0. a hetMlon Agency <br /> 1 Form Approved OMB Na.1050-0039(Expires 9-3096) See Instructions on back Cage 6. Department of Toxic Substance.Control <br /> Please print a type. form designed for use w effte(121p' writer. .�,/ 5«ramento,California <br /> 1 UNIFORM HAZARDOUS 1. C>,nerator's US EPA ID No. Manifest Document No. 2. Paps 1 Information in dol hassled areas <br /> WASTE MANIFEST h not required by Federal low. <br /> IAIA111101113191315121019 11 11 <br /> 3. Ggqrose�ratator's iiNaatmee andMailingAddress C <br /> �Th,ne�7�Cboy�t. 3D06odi <br /> 4. GUtlMa1 PIM1fi (952 1-1910 -6800 e <br /> xt <br /> 5. Transporter 1 Company Name 6. US EPA ID Number <br /> gp Jia Thorpe Oil, Inc. <br /> CAL 0 0 0 0 1 2 8 8 4 <br /> Q 7. Transporter 2 Company Name R. US EPA ID Number <br /> V <br /> U) 9. Dedgnmed Facility Name and Sib Addreu 10. US EPA ID Number <br /> Z <br /> V-46 R�'lbim$na bn�• <br /> J Q� Q Silver Springs. NV 89429 IN IV ID 1118 12 13 15 18 14 IS 13 <br /> V 12. CoNdnen 13. Told 14. Unit <br /> 'A Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No, Type, Guonfily Wf/yd <br /> "' Used Underground 44 Oil Storage Tanks h <br /> 05 <br /> 3 0 00I 00002 &A <br /> E <br /> go H Is <br /> E <br /> R <br /> A <br /> TC. <br /> O <br /> � R <br /> W <br /> F Z d. <br /> 1 W <br /> I r U <br /> Z <br /> O <br /> ta/t <br /> W <br /> tY <br /> J <br /> Z <br /> Z <br /> 15. Spedd Handling Imhuclens and Additional Information <br /> a Appropriate Protective Clothing <br /> Z "Eaangfil Contact: (209)368-6175" <br /> Saes E.B.G. Page 31 <br /> 16. GENERATOR'S CERTIFICATION: I hereby d"m that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> U pocked,marked,and labeled,and are in all respects in proper condition for transport by highway according m applicable internatiotel and national government regulations. <br /> If I am a large quantity generator, I certify that I haw a program in place to reduce the volume and toxicity of waste generated to the degree I haw determined to be <br /> i ecommkolfy practicab4 and that 1 have selected the practicable method of treatment,storage,or disposal currently available to me which minimize.the present and future <br /> N threat to human health and the envlromnentr OR,if I am a small quantity generator,1 flow made a good faith effort to minimize my waste generation and select the bast <br /> an waste mama anent method that is available to me and that I can aflord. <br /> O Printed/Typed Name Sigrnq t",� Month Day Year <br /> Richard Thorpe 0 1, 11 10 9 IS <br /> Z 1 17. Transporter I Acknowled Materials <br /> of Receipt of Materlo <br /> W A Pd /Typed Name Signature r ! I fy. Ma111 Day Year <br /> If <br /> W f �rYA <br /> F ' _ <br /> ar 0 18. Transporter 2 Acktwwled emenl of Receipt of Materials <br /> A <br /> i Pdried/Typed Name SloroNre Math Day Year <br /> ¢ <br /> V <br /> 1. <br /> yl 19. Discrepancy Indication Space <br /> I U F <br /> Z C ' <br /> L <br /> 120. Facility Owner or rater Certification of receipt of haxardws materials covered by this manifest except of noted in herrn 19. <br /> T' <br /> Y Primed/Typed Nome Signature,Signature, MosYeart Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/95) Green: TRANSPORTER RETAIN <br /> EPA 0700-21 <br />