Laserfiche WebLink
Ild, <br /> runt or I e. Form designed lar use elite /17- itch 1 ewrifer. TO%IC Substances Control Division <br /> Sacramento,California <br /> UNIFORM HAZARDOUS Dener a US EPA ID No. Manifest 2. la, <br /> WASTE MANIFEST Document No. Information In the shaded areas <br /> Is not required by Federal law. <br /> enerator's me nd Mailing Address A. State ManbNt Document Number <br /> I Ge�� ejfm ��, 00,o&x <br /> Generalor:s Phone tallQ S7 �,.�.1 / '/li oar Q���y a. State J9 a ID <br /> -5707 <br /> o,v(J <br /> Tris moa Name 3. US EPA ID Number C. State Thereinafter,ID ej <br /> e 7 D. Tnaponera PhanTranepaner. 2 Company ems 8. US EPA ID umber E. State Tranaponer'a O <br /> /— l 4 rte b . Tranapo l ea Pho Q <br /> 9 Designated Facility Name and Site Address 'T 10. S EPA ID Number a. State Fspllhy's ID' _ <br /> �C///BnnG /1G'rpfcYiil J-c' <br /> IL F IIRy,s Phase <br /> C4 q G 0 7_ 7i o <br /> 12. Container w.. 13."Total 1e. 1. <br /> 11, US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> a No. Type Wt/Vo <br /> E wus� ail Ci -i&6�ibte Lt ' iJ Stat. <br /> Nr1 IqI0 EP /Otna <br /> E b. Q <br /> R Slate <br /> A <br /> T EPA/Other <br /> 0 <br /> R c. <br /> 6tate <br /> EPA/Othar <br /> d. <br /> Shb <br /> EPA/Olhar <br /> J. Additional Descriptions for Materials Listed Above - K. Nepplln9 Codes lar Wastes Listed Move <br /> b. <br /> R,x,su-k 4 w41ev- <br /> A& f d. <br /> 15. Special Handling Instructions and Additional Information <br /> 16. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping <br /> name and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable <br /> international and national government regulations. <br /> If I am a large quantity generator,1 cenity that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have <br /> determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available l0 <br /> me which minimizes the present and future threat to human health and the environment; OR, If I am a small quantity generator, I have made a good <br /> faith effort to minimize my waste generation and select the beat waste management method that is available to me and that I can afford. <br /> Printed/Type Name / Signature Month Day Year <br /> R 17. Transporter 1 AcknowIF <br /> ledgement of Receipt of Materials <br /> A Printed/ pe Nema Signature <br /> N - Month Day Year <br /> S <br /> P G <br /> O <br /> 0 18. Transporter 2 Acknowledgenuint of Receipt of Materials <br /> R Wintedl <br /> T Typed Name Signature Month Day Year <br /> E <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Faclllly Owner or Opareicr Certification of receipt of hazardous materials covered by this manitut except as noted In sem 19. <br /> VPrinted/Typed Name Signature <br /> 6022 A(1/87) <br /> e7ol7002z <br /> White: TSDF SENDS THIS COPY TO DOHS WITHIN 30 DAYS INSTAU6TIbNS` ON TNE,SACK <br /> � <br /> 9-88) Previous editions are obsolete. <br /> To: P.O. Box 3000, Sacramento, CA 95812 <br />