ARCHIVED REPORTS XR0002693 - Laserfiche WebLink

Home Browse Search

State of California—Environmenfol Protection Agency Form Approved OMB No.2050x0039{Expires 9-3494) See Instructions on back of page 6. Department of Toxic SO)sionces Control Please print or type. form dtsioned for use on efite(17-pitch)rypewriter. Socromento,California UNIFORM HAZARDOUS 1, G'enerator's US EPA ID No. Manifest Document Noy 2, Page 1 Information in the shaded areas WASTE MANIFEST = A -1 (, 5F J � 6 7 .1 o 1 is not required by Federal low, f f 3.'.Generator's Name and Mailing Address A Sfite 7+wgtde�Documerd tJumbef`�s^}drt"� 2 l z 1-'•r,n o HESS DUBO I S CLEANERS 348 HARD I NG WA'{ S i Ot�KTO d CA S '04 WAY, S State Csenerator s 1D �,' ry.P Z:7 r 1C 1 Su,sy=N�v- v' �,/"u 7`;j` `Ty=F•�—.: j Y w�..t ; yNt d. Generator's Phone (2'0`3) to 5. Transporter 1 Company Name 6, US EPA ID Number00 ' t rti HAZARDS - - . s D"7ranspoAerFi'PFwrteras �F.GI HAZARDS OLUT'IO.NS INC f= .1t) t� c (i E, r • ' E -r ` 7 s t A 809Y7 5 7 49 7. Transporter 2 Company Nome 8. US EPA ld Number E'3St6te Transporter%ID rr € aps Q 9. Des noted Facility Nome and Site Address __ 10. US EPA M Number G State Facrl jZ STAi EWYLDE E'�VIL Rt...N..`r.' 117 mac: -`vlTl_F`'. .sti:_ LL- s _ H FacilttysPhone f. lett E' r-7 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number L 12. Containers 13. Total f4. Unit Z PpPi9 ) No. Type Ouantity Wi/Vol l:Wasto Numbar;�i ". iAJ-it r.3 G ,-lyr;'V:`[\'iY Li{� .��, I !-'aril_ f_.t- C-rF .1rt1r�):J E EPAfbther �: r� o E U ?� co N b. Stwel, i �,` - a, E r` 6 A I EPA/Other' r C) T c• r cb QLU Slate EPAJOther Z d' StaLW le' LU EPA/Other M 7 Addd anal Desc ptrons(or Materrali i sled Abase �l - i tC ,Hondiing'Cc, for Wastes Listed Above i '.,.(r. � 3-a�a� .'.'✓ V.. „^.z .ISd t sz ,6 F;'� SR"�l"" �' ` i c f -'i tg Y' S'- 3 s bt�t :?fag'` s`:6..3. LO �rjQ 3 FFIi S QE TCIDY'� 0`y r 1 I-- 4., :.c LU c _ SO FE ��.�LE� Z 0 1$. Special Handling instructions and Additional Information �-- ,�M'�.•s,•�:i'�.T A T 1-`•�,r-1�-E 1_ 1 r,i L t~_{..:T -i,�H 1 ' Z t.E 1 YE R I_Etkf_Y CON'rACT: i.C;.y-t 1i 3iJ--' LU F- J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fu)ly and accurately described above by proper shipping name and are clossified, ' Q paAed,marked,and labeled,and ore in oil respects in proper condition for transport by highwoy according to applicable international and national government regulations. U if I 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 t have determined to be economically practicable and that I have selected the practicable method of treatment,storage, or disposal currently available to me which minimizes the pfesent and future threat to human health and the environment; OR, if I am a small quantity generator, I have mode a good faith effort to minimize my waste generation and select the best ' waste monogement method that is available to me and that I can afford. a Printed/Type ome Si notvre �„ ant Day Year U 17. Trans orter 1 Acknowledgement of Receipt of Materials Z o ' Lu A Printed/Typed Name Signature0 F4 t Mo Day Year o 18. Transporter 2 Acknowledoement of Receipt of Materials I.LJ N E Pri to Typ Nome r Sign r nt Day CYear LU 19. Discrepancy Indication Space Lo Q F U A ' Z . 1 0, Facility Owner or Operator Certification of recei i of hazordous materials covered by this manifest except as no ed in Item 19, T Printed/Typed Name Signature 9 Month Day Year DO NOT WRITE BELOW THIS LINE. DTS.. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAY5_ EPA 11022A (9/93) (Generators who submit hazardous waste for transport ovi-of•state. EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 cloys.) z