ARCHIVED REPORTS XR0010686 - Laserfiche WebLink

Home Browse Search

Stale of Cohlornia—Envatir mental Protection Agency Form Approved OMS No X050-0039(Expires 9 30 99) See Instructions on back of page 6 Deportment of Toxic Substances Centro' Please pent or type Forr designed for use on elrte f 12 prtc~)typewriter Sacramento Coh(ornio I Generator s US EP,y,ID-Ncs Manifest Document No 2 Poge I Information in the seeded,,a{reas _ UMF�RM HAZARDOUS a ` Is not required by Feaerpr -- WASTE MANIFEST cD7 ' Lr ' off ' r(�1� r ors Nopse and Mo lid Address A State Man,es!Docament.`.Number�Sl99318056 ,O 3 1 8 0 5 6 , {l L` {r� 1L +t,/ t- el rs $ State Generator's 10 ba A Generators Pnone r? ) - - fns ct -597— j w l r-7 ' LO CN I.,, Transporter 1 Company Nome _ 6 US EPA ID b Numer C- $tate Tn4orler rve s ID Resed snr M1 ry+ a ) r �,.s"`"S rn' ' It ^-a•^r<". r;F` 1 o __i - ) L) , ti _1 D Transports s PhonCD e 7 Trarsporler 2 Company Nome 8 US EPA ID Number E State Transporter s I eservedI i, - —. Q I I F Transporter �v 9 Desianotecf Facility Name and Site Address 1D US EPA ID Number Gy State Fa iiliVs,ID,, a"Y w Y Y v Q ter_`_'?i111 G�:2 �1 , �sTC. -T t? 8 $ 2? L_�C� vrrl11 .i n;�. ~ Ys �u)S:{fir :�w HvFaerlttysP(toiioT^T "F ,•" d s`-sr 'e l�0 a.T�...} Lin �. !�r y�1♦ 950 -'� ._. 1r' .,- ' ' •``s.� — 1 I r� 12 Containers 13 Total )4 Unit 1U 11 US DOT Description(including Proper Shipping Nome Hazard Class and ID Numoer) No Type Quantity Wt/Vol ?_Waste plumber _ o i � Statd.r 'Y'r y 3 G 1, a,R A Zr-) U>rD 1O14.t r 1 EFA10them, G CV Ebco cc E rr A"1krtiLrrw Sl=t'*�'"� co ,EPA071�f, tic" ecrs i CV R v A s 77 � C $la $r� K 1 o T =�M3 �'vC r to Rr'`" ILL) d St`a3r i �4 >s„ � s J,f3t+ Y �' ditiona€�pscn�iio+u LW ti "Nlefeflalilssled Abb're'x+ x' k lsdfln$Coaea!~orlNasteil �~ v r > Ckf Q s -1LLr ,17 tiLS. `Iw�yt t?4 l 'r'�h's. v "_►a...W "�.� w r1€ t a^ i��" ..s a e CY15 Special Handling Instructions and Additional Information ~ E r�sT T r i 7 S STANDARD Z USt, 3_iN0�1t2s3 S��.Fi.:l FZ�CAJ. IJ[�i, T�zd7 Sa�,.vt7AZ0 Pte. 24 HOUR FACILITY ( 831 ) 427-3773 _ = 24 HOUR G^i.Ti'.R��0- (209 ) 545—;3130 �,C ' r cl tCL 1a Ser1��>✓n v 16 GENERATOR 5 CERTIFICATION 3 hereby declare that the contents of this consognment are fully and accurately scribed above by proper shipping name and a e classified packed la7 marked and labeled and are m all respects in proper condition for transport by highway according to applicable international and national government regulations If I am a large quantity generator I certify that I have a program in plctce to reduce tfse vo;ume and toxicity of waste generated to the degree I have determined to be economicol)y a practicable and that l hove lected the practicable method of treatment storage or disposal currently ovorlable to me which minimizes the present and future threat to human health N s� � and the environment OR if 1 am a small quonF,ry aenerotor I hove meds a goad forth efforErto minimae my waste generation and select the best waste management method that is 0 available to me and that 1 Tian afford } Prjn1ed/Typed40ome iii V_r Signature ' Month Day Year � w5� ley Ui A 17 Transport 1 Acknowledgement of Receipt of Materials CV p Printed/Typed Nom $�gnpivre / Month Day Ye � P 11A14/49 � • � � s Ig 11 LL0 16 Trans otter 2 Acknowled ement of Receipt of Materials 0 T Printed/Typed Name Signature Month Day Year Viii E Q R f 19 OTscrepancy Indication Space i z A C I L I f 20 FaultOwner or Operator Certification of recemt of hazardous materials covered b this manifest exce t as noted in Item 19 T Printed/Typed NS ignature Month Day Year �Y 1 1 sr l�(� '�/ r ' / 1 / �+ C- r I� ' DO NOT WRITE BELOW THIS LINE Tri'' -10 C_' --Oi ^n[ ni^ v ft^ si-ml zz—rj: "s a ^nsmo OUT C OI DTSC 8022A {1/99) D EPA 8700-22