Laserfiche WebLink
>1 , <br />yL <br />h <br />c <br />C <br />C <br />C <br />c <br />C <br />C <br />a <br />U <br />u <br />U <br />L <br />C <br />0 <br />LL <br />a <br />a <br />C <br />a <br />z <br />LL <br />F- <br />Q <br />L <br />v <br />oe <br />C <br />} <br />L <br />Z <br />LU <br />LU <br />< <br />G <br />LU <br />O <br />LU <br />LO <br />Q <br />V <br />1►J <br />flrore of "wornta—tnnronmenrat t•rotectiartrsgency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-' <br />Please print or type. Form designed for use on elite 1 <br />DO NOT WRITE BELOW THIS LINE. <br />DISC 8022A ll/99) <br />EPA 87700-0-22 Green: TRANSPORTER RETAINS <br />UNIFORM HAZARDOUS <br />1 • Generator's US EPA ID No ;: Manifest Document No ':x + 2 gage Information m the shaded breas <br />WASTE MANIFEST' <br />ff is not required by Federaliaw. <br />of <br />3. Generator' j�I mL'e�d M�1Iia�Ad rest �, �y <br />A- Stote'Manifest Document Number :' i <br />2147J- 7081 <br />B. State Generator's ID <br />4. Generator's Phone ( .:�rxf) �1!`ro..d,,,•.! " fo' e.7• F <br />- - <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserved.] <br />� <br />AF7-TY—KL 1EN S` ZTEIMS INC. SCR000075150 <br />D. Transporter's Phone <br />jI <br />I I I I I I I I I I 1 <br />800 663-5640 <br />J <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID [Reserved.] <br />J <br />( <br />1 <br />F. Transporter', Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />05 :)144 <br />G. State cilOity's ID9 <br />( <br />1 <br />T T t 7 li 7 <br />Lt�a:1 BE4%'R ri `j SA RD CAD05949431Q <br />H. Facility's Phone <br />J <br />CA 95.1.33 1 1 1 1 1 1 1 <br />1 $00 545-3353 <br />1 1. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14. Unit <br />_. <br />1 <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />a <br />e101:Y—:2CRA HA'ZARDQUIS WASSTE LIQUID <br />State <br />222 <br />DoT REGULATED) <br />TT <br />G <br />EPA/Other <br />i <br />t N <br />b' <br />State <br />i E <br />EPA/Other <br />t R <br />t A <br />T <br />State <br />O <br />EPA/Other <br />R <br />i <br />d. <br />State <br />i <br />i <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />a. 14 b. <br />15. Special• Handling Instructions and Additional Information o'� <br />J <br />MFST R/TOC100b0000 Q-00Ci-0U V <br />7 �E?;3C;�1tCY RESP ?300-468-1760( 24 HR). IF UNDELIVERABLE RETURN TO GEN-RATOR. <br />;%CIRP r11:.sT14.0RIZE.1 TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESS'AR`I. <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled, in for <br />and are all respects in proper condition transport by highway according to applicable international and national government regulations. <br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume qnd toxicity of waste generated to the degree I have determined to be economically <br />practicable and that I have selected the practicable method of treatment, storage, or disposal curr' oily available to me which minimizes the present and future threat to human health <br />and the environment; OR, if I am a small quantity generator, I have made a good faith effort to Minimize my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />Printed/Typed NameSignature <br />f <br />J �`• <br />,Month Day Year <br />t .. I .t_ >;: � l 1 <br />�l t << ''�^–i'd''4-, t.: ✓ <br />1 1 � i t-. <br />RT <br />77. Transporter 1 Acknowledgement of Receipt of Materials <br />A <br />Printed/Typed Name 4. <br />Signature f <br />Month Day Year <br />P <br />f ..� <br />, <br />0 `� � <br />18 Transoorter 2 Acknowledgement of Receipt of Materials <br />TPrinted/Typed <br />Name <br />Signature <br />Month Day Year <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest a cel t -as dfea.in Item 19. , <br />T <br />Printed/Typed Name -••--- <br />Signature �`� r// �: <br />Month/ Day Year <br />/ <br />j <br />DO NOT WRITE BELOW THIS LINE. <br />DISC 8022A ll/99) <br />EPA 87700-0-22 Green: TRANSPORTER RETAINS <br />