Laserfiche WebLink
State of Cohloirim—Environnantal Protection Agency <br /> Form�aproved 0 f.B No.2050-0039 IE.piree 0.30991 See Instructions on back of page 6. Department of To..c Substances Control <br /> Pleor print or type. Form designed lar use on shoo 112-puch)typewriter Sovamento.California <br /> UNIFORM HAZARDOUS 1 Ganeratoi s US EPA 10 No mom—first OOcument No. 2 Pogo 1 is mol required <br /> a the shaded orws <br /> is irol required by Federal do.r. <br /> WASTE MANIFEST f IL1010 ® 01y1 lit7 6 3 a' 1 EES8 <br /> 3. Generators Nome and Ma:hng Address a A.SftM MoniFatt OOMW W t NWt bW <br /> % td°O'ley O.i co. 9673 636 <br /> /66 r4.Rvec Geat®O S'TOCK?aN/ CAe '1f..�OG B,51040-morarors"D <br /> AA. Gmwrator's Phare Ida')I y'S/e- <br /> C14 S. Transporter t Company Noma 6 US EPA ID Number C.She Tra sponoWs ID <br /> EVERGREEN ENVIRONMENTAL SERVICES C A Q 9 8 2 4 1 3 216 2 D 800 972-5284 <br /> aD 7. Transporter 2 Campo"Name 8. Wfi CPA tD Numog., E.Stats Ttatspafers ID <br /> ;TC'�✓lJt C..C2 <br /> Q ) ! 1 C L F.Traasp~s <br /> 9. Designated Facility Nona and Site Address 10 US EPA 10 Number G.Stals Foci' s ID <br /> SOLVENT SERVICES,INC.dba LAIDLAW CAD01 15 191,4191413 1 0 <br /> c.� 1021 Berryesa Road H.FocMWs Phone <br /> San Jose CA 95133 ICIAIDIOIS19141914131110 1-408-451-5000 <br /> G t 1. US DOT Description[including Proper Shipping Nome,Hazard Clots,and 10 Number) 12. Containers 11. Torol 14. Unit <br /> P`teJ No T Quantity 1,4 1. wash Nemb.r <br /> ati I <br /> '3 c Non-RCRA Hanrdous waste,Solid ® c D I M (,5'�o I G P ""Non-RCRA <br /> E o <br /> N b State <br /> ® E <br /> H R EPA/Othn <br /> v A c. state <br /> R I l i 1 1 1 1 EPA/011%w <br /> cc sro» <br /> d. <br /> Z <br /> U I EPA/Odw <br /> W <br /> 4n 1.Additional 0trwiptions is Rbwiols Ustd Above K Mandkiing Cadets For Wath Usk Abom <br /> Z ` <br /> O p r I _ _ _ _ 1 °7 0. r b, <br /> ' _ % o_ <br /> Uj <br /> acc, d. <br /> Q 9910 <br /> Z <br /> 0 15 Special Handling Imsrw000ns and Additional Information <br /> 424 Hour Emergency Response Telephone No.:510-795-4401 Invoice f 6 7cP SAF- <br /> ZDOT ERG 171 WEAR PROTECTIVE CLOTHING Sales Order <br /> & A6_14P a rr <br /> 16, GENERATOR'S CERnFICATIONs t hereby declare$hot rhe conronh of this conogni m are fully and occiratelly described above by Proper shipping name and are classified,pocked. <br /> Q marked,and labeled,and ars.n all mspee$s in prop.,concision lot t,ansport by highway according to applicable.nter.atisma)and moeionol po+nrnmeni tegubtrons <br /> V <br /> 111 am a large quarry generator,I certify thus I lave a program nn place to reduce the volume and to.iary of waste generated to the degr»I haw deteom.ned to be ocomomicallr <br /> �- pract cable uncithat 1 lane sebNmi this Mlicabb method eF nwem.ml,NWage,a disposal currently available a m which m.nineles flue pr.Mnt and future Ihrout to human heath. <br /> and the enrronmenf;OR,uF t am a small quarry generator.I haw mads a good faith effort to minimize my waste generation and sclect the best..acro manog—t method dot.s <br /> Cie avotbWe ro ea and shot I con afford <br /> o <br /> >. Printed/Typed Name Signatu. Month 0, Yew <br /> z N C.r Asp <br /> W t 17 Tram t,u I Ach.—lodg=ent of Rec.i t of Moterals <br /> .Cie W 6 Pllnted/Typed Nome Signature Month Day year <br /> ti, : dC P L�GTD onJ r_tlt,�•� O 1.3 1.3 1/ 14 ICS <br /> U. a t8. Trona 2 Acknowled f Retinal of Materials <br /> Sig re tori utti _ tt» v„w <br /> T Printed/ -- t <br /> W <br /> H It C_. YD <br /> V19 Discrepancy lndicalron Space <br /> Z F <br /> A <br /> C <br /> t <br /> l <br /> l 20 Foc.ti Owwe.orOperator C•rtif.mtion of recti !of IazardOaa materials severed the monif.nt encept as netnd in lam 10 <br /> j Prunrod/Typed Nome Sigtaro �\ ^ Month Day Yaw <br /> v VLi I eN (" CA <br /> DO NOT WRITE BELOW THIS LINE. <br /> Who. M'Z f S1[N05 !H15 COPY TO OTSC WITHIN 30 DAYS <br /> OTSC 8022A 14/971 To P O Be. 3000, 5oc•oro—to. CA 0581: <br /> EPA 8700-22 <br />