Laserfiche WebLink
e�16_, Depaament of Toxic Substances Central <br /> �trr.:nra—Lm�rgsrnensa!Yrosectwn Agency - See Instructions on back o� peg <br /> i- .oved <br /> OM$No.2050-0079 IExores 9-30-991 Socramenb,California <br /> plot a type- Form designed for use on elite f12-pi")typewriter. j <br /> 1. Gaserato�s L1S EPA ID Mo. Manifest Document No. 2. <br /> Pogo 1 lnfornsatiart in the shasfed areas i <br /> isnot required by Federal II I, t <br /> IlN1FOol <br /> RM IiRDOl15 L' 7- p / t <br /> WASTE !FIFEST <br /> O �2 J <br /> X'' W 'L r1F Y� ti i <br /> ' (ieneratols Momsiing Address - <br /> .t- <br /> Pacific Bell <br /> Box -Room 3EOd0 San R� CA Adm <br /> p t <br /> I 6_ LIS EPA IU Number <br /> .�... 5_Transporter 1 ComponY Nome r• •xl },fir <br /> a �r: <br /> Nbmber { <br /> T. Transporter 2 Company N- <br /> 9. Desi6patad Foci6ty Name and Site Address 10. US EPA ID Number p <br /> 2W ft Road _ - <br /> 1 toilers } 13. Toles! 1�. Un <br /> 11. us DOT oe3t.ipliam iincludimg Propwr Shipong F'-:', #ioiord Cbss,and 117 Nunrberl No. 11 j__ Oaanfity 'WING! <br /> •s <br /> ,has,3 11ti/493. <br /> C. <br /> :5 E <br /> 3 � - <br /> 'V t: � h <br /> z <br /> 15. Special Handling lestnrclic s and Additional In Formation s` yi.! _ ___ ___ J <br /> read proper pi-otea"�ii'tie eyi3`s�nTie:ia 1lr1Fi� hai+auirry_ 1t1�TCiyera, v1 v�naiRreea a>Ic sr�►Envwiiraa_2� <br /> Hour emergency telephone number J-916-977-7777 (Pacific Bell) ERG#128 c r <br /> x; <br /> r•R 7 aur ,,:ate —..31�� !U!4 .' <br /> e al a contents of ibis consi nrncnt ore Fatly and accurate described above by proper shipping none and are classified,packed, <br /> 3 CERTIFKA 1 ebY I and nes}sand nment regulations- <br /> marked, <br /> accurately <br /> 6 internotiona Saver <br /> 1 b. G£ g ordi b hco k <br /> ' marked,and labeled,and are in ON rospech in proper condition for transport by highway according aPP I <br /> II I b be ecorwmicaR <br /> the degree I Rsave determined _ <br /> H 1 am a large gaanhy ger creta*,I serol that 1 have a pr rom in place to reduce tR a*plume w.d toxicity of wasee aro►od to dagr <br /> practicable and that 1 hue sele "'Id and Foure dweco to <br /> cted the prod table m ,a°nmade a good Faith ealRort to en!ly ri.m to me w!iichamiand a best waste management mell.od that is <br /> and the environment,OR,if 1 om a smu quantity gene* Y g< at <br /> avaryable ro me and that 1 can offord_ r <br /> - � Ahonlls Day Year <br /> Prinbd/T a . — /�f $ D <br /> l C�jr <br />{ •1 17, IraI 1 Acknowledgement of Recei als <br /> R <br /> Signature �. <br /> Moth D- Year <br /> rey <br /> i •R 18. Tran rler 2 Ackrrow! nt of Receiptof Materials µamt}, Day Year <br /> RPrinted/Typed Name Signature <br /> T <br /> •R <br /> j 19. Discrepancy I�icotion$puce ,��i <br /> F � <br /> A I al <br /> C h <br /> L <br /> I I 20. FaciFi Owner or Op <br /> dTd Nrasor.Cer1l(K-tian of recei of hamrdous materials rnverad b this manifest exc t as n tad in Items 19. Math Day Yen* <br /> T Printe /ypeame Sign <br /> Yature • •�{ <br /> , r M 3 <br /> DO NOT WRITE BELOW THIS LINE. <br /> White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> 022A(1/991 'I To: 1 P.O. Bax 3000, So<romento, CA 95812 <br /> EPA 8700-22 - <br />} <br />