|
Stole of California—Environmental Protection Agency
<br />Form Approved OMB No. 2050-0039(Expires 9-30-99) See Instructions on back of nage 6. Department of Toxic Substances Control
<br />Please Print or type. Farm designed For use on ellle 112-pitchl vriter. Sacramento, California
<br />�V
<br />IF <_
<br />"Z
<br />a<
<br />)0
<br />J�
<br />d V
<br />_Z
<br />x
<br />t-
<br />CQj
<br />0
<br />m
<br />m
<br />e
<br />0
<br />m
<br />oe
<br />Z
<br />Z
<br />w
<br />U
<br />w
<br />N
<br />Z
<br />O
<br />Or)
<br />w
<br />z
<br />ZZ
<br />O
<br />a
<br />Z
<br />w
<br />x
<br />V
<br />a
<br />O
<br />U
<br />Z
<br />C7
<br />W
<br />DO NOT WRITE BELOW THIS LINE.
<br />PR4r,;P A)02000214.649-13'zt3!}t].1c�,'7 ; L7__-__
<br />SNFi. t ? )00,1003h?92 A 4tit?-4=ytl'35'r3-t- _'' ' }-QdQ411?^?'3-9
<br />DISC 8022A 11/991
<br />EPA 8700-22
<br />NERATOR RETAINS
<br />UNIFORM HAZARDOUS
<br />eberatori U� 5 EPA 1D gifast Q current N
<br />—
<br />2. Page I
<br />Information i , the shoded areas
<br />y <, ,� „p ; f ' :
<br />s not required by Federal low
<br />WASTE MANIFEST
<br />f
<br />of
<br />1
<br />3. Ginnemtar's Name and Moiling Address .. . V; t- r- ...: .. _ L` i, s"
<br />A. SO. Manifest Document Number
<br />G
<br />//� ^^// (/y�� [L``,( //yy��E ^^//!/�' %
<br />2`94920
<br />^AF,:i�c;IE STREET
<br />1
<br />S. Smote Gan... tors to
<br />ie,,%NTE CA -;'A 'i :i 36
<br />4. Generator's Phone I _2 O) i '- 5 J
<br />5. Transporter I Compony Name 6. US EPA ID Number
<br />C. stab TranspoMr's ID {Reserved]
<br />-
<br />D. Transporters Phan.
<br />-
<br />A,OC S69-S?=s0
<br />7. Transporter 2 Company Name 8. US EPA ID Number
<br />E. State Transporters ID (Reserved.)
<br />F. Transporters Phone
<br />9. Designated Facility Name and Site Address `` _ 10. US EPA ID Number
<br />G. Slate Fyci i '19* 1 r., t' 2
<br />3
<br />.t ,:j :Oi4 1 tiC
<br />t°1UNT1,403D AVE C,AI:r--8%4 i1.'3'.i3
<br />H. Facility's Phan.
<br />7rl'C4d,',RD CA 94 -3 x;
<br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Nominal)
<br />p h g p FP�ng I
<br />12. Containers
<br />13. Total
<br />14. Unit
<br />No.
<br />Type
<br />Quantity
<br />Wt/Vol
<br />L Waste Number
<br />•. AQ HASTE �ii'iTE.I?S. 'riET r!LLED 'WITi-1
<br />state 131
<br />.
<br />:�I. K.�4I t;• 73it•2.. ,:i .7 _T ( ERG 415'4 �
<br />TJ7'
<br />?
<br />EPA/Other Dfi l�.(
<br />G
<br />E
<br />` /
<br />N
<br />b__. -.,w
<br />Stab
<br />E
<br />Dn.� { {' F1:Q--Yi�']'-'9-"t�-• 'ItH-�ti.+a-) __�..__.
<br />_
<br />_
<br />�..___�..�
<br />a'„�,
<br />tl IT
<br />T
<br />a BATTER T_ L J... -1.%R ..._..C-').NT.A-i 4A" I --4G": — RC. ,.A YA.-i-14.M
<br />t.
<br />State
<br />O
<br />R
<br />UN .3 l`':-
<br />d
<br />State
<br />EPA/Other
<br />J. Additional D .... ipfiom for Materials Listed Above
<br />K. Handling Codes for Wastes Listed Above 11
<br />!A) D005
<br />a 14 b -1---7• ,
<br />c.
<br />d.
<br />rT-
<br />15. Special Handling Instructions and Additional Information _
<br />- 2t , HER rc 4 FTU s O 3 _'
<br />' o _ ,�(_ � _ 'tNDE(IyExn_�� R v, { f ,�'JT�RA�•..k:.
<br />3K i.4 U..,QCvsz, "fl iSt 1; ELN ZD ;IiBCE/)',,i?: :ARNIE,: 1_ h7EC% 5,4P.:.
<br />I-�-
<br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipring name and are classified, packed,
<br />marked, and labeled, and ore in all respects in proper condition for transport by highway according to applicable international and notionaPgovernment regulations.
<br />IF I am a large quantiq generator, 1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically
<br />practicable and that I ho D selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the and future threat to humon health
<br />present
<br />and the environment; OR, if 1,.m a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is
<br />available to me and that I can afford.
<br />Printed/Typed Nome b _ t
<br />Signa
<br />Month Day-- Year —
<br />i
<br />17. 1 orsEmrter 1 Acknowledgement of Receipt of Materials - -
<br />pPrinted/Typed
<br />Name
<br />Signature': �^
<br />Month Da Year
<br />y..
<br />P
<br />/
<br />0
<br />18. -Transporter 2 Acknowledgement of Receipt of Materials -
<br />iPrinted/Typed
<br />Nome
<br />Signature
<br />Month Day Year
<br />E
<br />0
<br />19. Discrepancy Indication Space
<br />F
<br />A
<br />C
<br />I
<br />20. Facility Owner or Operator Certification of receipt of hazardous materials
<br />covered by this manifest except as noted in Item 19.
<br />T
<br />Printed/Typed Nome
<br />Signal.,.
<br />Month Day Year
<br />Y
<br />DO NOT WRITE BELOW THIS LINE.
<br />PR4r,;P A)02000214.649-13'zt3!}t].1c�,'7 ; L7__-__
<br />SNFi. t ? )00,1003h?92 A 4tit?-4=ytl'35'r3-t- _'' ' }-QdQ411?^?'3-9
<br />DISC 8022A 11/991
<br />EPA 8700-22
<br />NERATOR RETAINS
<br />
|