Laserfiche WebLink
Seetnsitrucu-rra <br /> 7 Sacramento, <br /> state a of Calftornie--Health end Welters Agency and Front of Pi j <br /> Rate of roved OMB No.2050--0039(Expires 9.30-9 writer) 'j'' <br /> plea o.type. Form designed for use on elite ° ,r'a US EPA ID No. Mamfeat .2 le 1 Informat[on in the shaded areas <br /> ;. Document No. is not required by Federal law. <br /> UNIFORM HAZARDOUS r <br /> WASTE MANIFEST <br /> ' A. Stats ManMest Docun�t �,. •k <br /> 3. Generator'$Name and Mailing Address <br /> �i .i.y ✓ <br /> St. B. State Generator's ID <br /> 4. Generator's Phone( ) _F �r C. Stats Transportu s ID r- <br /> 6. Transporter 1 Company Name 8 <br /> US EPA ID Number <br /> D:Tranapoi see Phone ,�• �, <br /> 7.'Trs isportei 2"ComPanY Kerne` <br /> g, US EPA ID Number E.,state Trartaporter's ID <br /> n F.Tattaporter s Phone _;tri:_+"•r <br /> g Destgn8t8d Faoflify�Name and Site-Add- <br /> 4-` 10. US EPA ID Number G. State facUihr s ID <br /> *til. t11S LJ4-. ��•i:•tL\_ - <br /> Fd t=a rPitate <br /> 12. Containers 13.Total 14. L <br /> 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> No. Type Wt/Vol <br /> S•:At .:io._, E :i :'.'ii-a lt.. Stern <br /> fi =fir' <br /> 6 Oti:::t Rev:-A'.ED- EPA/Other <br /> r. pr <br /> NStats <br /> i R b <br /> T RECEIVED EPA,OMter , <br /> O <br /> R jIM Ut 25auto <br /> ENVIRONMENTAL HEALTH <br /> r <br /> d. State <br /> i <br /> EPA/0111m <br /> ! <br /> J "dklonat Descriptions for Materiats Listed Above K ;Kttarldl�g Codes tot Wastes F fated Above <br /> „ <br /> • cr r t r eY . <br /> i f3•' :i�'���7Y �iw.�..�d� �� ��, R•��''�"�i.➢! �,� 1C. -.x�Y•'> _q i :.�i a ''S� <br /> ? z �C �'• tit 7 <br /> .;C7 <br /> 16. Special Handling Instructions and Additional Information <br /> �P:- 'ANK CA.h ACF" s.7 i ; <br /> I _. .•.:_ ..;T `:ii�. � _.. t":_� a:-„ TS 7..��-LI.._�i � ,.2t_ h; %,C!%.... L�:. t:.�. _ <br /> I <br /> i te. i <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> i and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> national government regulations. <br /> i <br /> H 1 am a large quantity generator,I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> i to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> present and future threat to human health and the environment;OR,if t am a smell quantity generator,I have made a good faith effort to minimize my waste <br /> generation and select the beat waste management method that is available to me and that I can afford. <br /> i Printed/Typed Name Signature Month Day Year <br /> j T 17. Transporter 1 Acknowledgement of Receipt of Materials r r <br /> R <br /> NPrinted/Typed Name Signature l. Month Day Year i <br /> S y <br /> i p <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials f` <br /> ! R Printed/Typed T Name Signature Month Day Year <br /> i E <br /> 19. Discrepancy Indication Space <br /> F + <br /> A 't <br /> C <br /> 1 <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in nem 19. <br /> T <br /> y Printed/Typed Name Signature Month Day Year <br /> -IS 8022 A Do Not Write Below This Line <br /> 'A 8700-22 <br /> ev.6-89)Previous editions are obsolete. <br />