Laserfiche WebLink
Form Approved OMB No. 2050-0039 (Expires ' <br />Please print or type. Form designed for use on elite (12 -pitch) t) <br />DO NOT WRITE BELOW THIS LINE. <br />C`. <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />Green: TRANSPORTER RETAINS <br />UNIFORM HAZARDOUSe� <br />1. Generator's US EPA ID No.Mahifait Documerlt,N m <br />€ p+ pd e 1 ¢, '< aforma4toq qn the ahadod arp� a <br />WASTE MANIFEST <br />OA Z 47 <br />�. <br />Qf is not required by Federal law. <br />3. Generator's Name and Mailing Address ,1 NAL S V <br />6540 'S AUSTIN1�i <br />A. State Manifest Document Number qq ��qq /�' e <br />I�r��' fA <br />CRLOC K <br />'# <br />t <br />STt.iCRTON CA 95215 <br />B. State Generator's ID <br />t <br />4. Generator's Phone ( 2 0 9) 4 E 0 6 0 �? 3 <br />i <br />i <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserved] <br />SAF ZTI'—KLEEIN 5 iS T MS INC. �.� �� % �rJ <br />D. Transporter's Phone <br />800 669--5844O <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID (Reserved.] <br />i <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />050144 <br />4 1 <br />4r -A t,✓TY.—KL EN SAIF JOSE), I <br />1021 BE cRy'E"NA RD CAD0594943.10 <br />H. Facility's Phone <br />CA 9511-33 <br />800 545-3358 <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 />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />a <br />NOI1N—RCRA HAZARDOUS WASTE LIQUID <br />State <br />222 <br />T.I , Yv11is�[i, L l)),}GE tlLJrs �::T REGULATED) <br />TT <br />EPA/Other <br />G <br />E <br />a f <br />N <br />b' <br />State <br />E <br />EPA/Other <br />R <br />A <br />T <br />C. <br />State <br />O <br />EPA/Other <br />R <br />d' <br />State _ <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above - - <br />K. Handling Codes for Wastes Listed Above - <br />a. b. <br />C. <br />d. <br />15. Special Handling Instructions and Additional Information <br />Mg, ST R /T# 1 017 0 4 8 6 5 0002-6033-98 <br />I' 'cG 117.111C14" RES:x Boo -468— 3."6o 2 4 HR) . II' UNDELIVERABLE RETURN TO GENERATOR. <br />;sk t;c�RT AU -71 ORIZED TO RETAIN LICENSER SUBSEQUENT CARRIERS AS NE(,rSSARY. <br />S IDO 0 D- <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 -,-end. aree in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />If I am a`(arge quantity gener far, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />practicable and that 1 have selected the practicable method of treatment, storage, or disposal currently 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 />Pnnled/Typed Name <br />Sign LureMonth, <br />1 Day Year. - <br />yw� <br />T <br />R <br />17, Transporter 1 Acknowledgement of Receipt of Materials ' <br />Printed/Typed.Nome Signature,%• - ------ - <br />,f ,... <br />Month Day Year <br />N <br />y i t , <br />0 <br />18. Trans porter 2 Acknowledgement of Receipt of Materials ,l.r <br />RPrinted/T <br />T <br />ed N <br />YP Name <br />' <br />Signature <br />Month Day Year <br />E <br />R <br />19, Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest.exce t as noted in Item 19. <br />T <br />Printed/T ed Name _. -- - <br />.YP <br />Signature na <br />lure i <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />C`. <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />Green: TRANSPORTER RETAINS <br />