Laserfiche WebLink
5t Pf CaWars�Environmemal Protection Agency <br /> .A,, OMR No.2030-00.39(Eepins 93041) SN IafihYCT10F13 OD back Tt b. Depertm w of Toxic 5ubstaces Con, <br /> T <br /> Btees/,' v,�ll'i cur Form desgned far vee on ekse(12-p hV W. �6 {/ r S«rarmum,California <br /> 4" 1. Generator s US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal low. <br /> WASTE MANIFEST ' Q I of <br /> 3. Generator's Nams,and Mailing Address <br /> 9OST� 73$ St37rRo'iT STGR%OYfST4 CAaF 9kS�/ * �. <br /> rid cc �J <br /> C4 4. $ivewrerato/s Phone (/ 'e170- <br /> °y s ID 1 jr <br /> S. Transporter 1 Companry'Nome . A ` 6. US EPA ID Number xs�¢j <br /> 7. Transporter 2 Company No. 8. US EPA ID Number <br /> 7— 9. Desi nested Fadlity Name and Site Address 10. US EPA 10 Number i., e 'sK,T{y, 1� F a"' `T• <br /> grilIF '1%1,Inc, I <br /> O 2S5 P.ztr'1 blvd. e <br /> 7 a Rist nund,C.4, r948Ji <br /> V 12. Containers 13. Total 13. Una <br /> Z 11. US DOT Description finclud'eg Pme <br /> r¢pe,Shipping Na ,Hazard Class,and ID Number) No. T Ouantiry Wt/Vol ,I.Was1p_' <br /> I— Ia.d!—it�..!(i% I lazar<kxiv Wa rte Solis] �. r <br /> r E 'Nast- F]itx c:.t�,raq.r '1'•r � oT P S I <br /> WN b' " ASTA COrhTPJ I^TinDl P0, tMt <br /> m E <br /> C4 R - p _ _LL <br /> O OCT 4 1994 " T- <br /> R <br /> w <br /> d. <br /> BY <br /> RAJ <br /> Its <br /> Z15. Special Handling Instrvc c,ns and Additional Informationt <br /> Keep away frc,ln sources of ignit o gays ear hardkot- " t� w;> k ng arOure i <br /> •:Z. U.G.S.T. 's 24 Hr. Contact NlTne � Ptlale:�i7�Sl�Z <br /> W <br /> H <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby dedore that the contents of this crosignmmt are fully and accurately described above by proper shipping name and are classified, <br /> Q .pocked,marked,and labeled,and are in all respects in proper conchiff n far transport by highway according to applicable international and national govemment regulations. <br /> V <br /> R I am a large quantity generator, I certify that I ha4..a program in place to reduce the v and toxicity of waste generated to the degree I how: determined to be <br /> -� ecomtnically practicable and that 1 have selected the prdFffmble method of keahnmt r qe,or I currently available to me which minimizes the presets and future <br /> threst'b human health ad-ths nnviiortmenh OR,N I am o small quantity ge„er h made, faith effort b minimae my waste generation and select the bet <br /> N <br /> wasteM21%9_1method th is a le b and that I can afford. <br /> K <br /> O Pr' Signature o12Mr <br /> y <br /> U T 17. Tran r 1 Acknowledgment of Receipt of Materials <br /> U, A Pante=/Typed - Signature Month /f Day Year <br /> Y s 2 <br /> W e1113 <br /> 0 18._Tnmvr 2 Ack,owlIdg..t of Recei t of Materiae <br /> W i Printed/7yped No. Signature Month Day Year <br /> LL. e <br /> O R <br /> W 19..Diucnpancy Indicotiop Spore <br /> F <br /> V A <br /> Z C <br /> L <br /> 120. FacilityOperator Owner or receipt tor Certification of l of hazardous mave <br /> materials cored by this manifest except as noted in Nem 19. <br /> T �p�y 1. 1 N i., re Monti, Day Year <br /> DO NOT WRITE BELOW THIS UNE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DISC•.8022A (9/93) (Generators who submit hazardous waste for transport out of-state, <br /> EPA 0700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />