Laserfiche WebLink
State of California—Environmental Protection Agency ; � <br /> F.Approved OMQ'NO.2050-0039(Expires 9-30-991 - See Instructions on back ofpage687622 <br /> Depodmenr of Toxic Substances Control <br /> Pleme print or/ype. Form designed for me on elite(Ibpikh)rypgwrirer. - SvcrameMa,California <br /> UNIFORM HAZARDOUS 1. Genmorods US EPA ID No. Manifest Document No, 2. Pegs I InformvYon in the shaded areas <br /> WASTE MANIFEST <br /> CAL 0 0 0 2 9 6 0 7 614 0 0 6 3 of j isnot m viredbyFederallaw. <br /> 3. �r�°1gI"�. spyy.....,-- A. Slate Manifest Document Number 24576478 <br /> 1550 SHAW ROAD — UNIT C <br /> �r�7 8-Stale Genmatar's to <br /> u`1 <br /> A. Generator's Phone7---i--- CA 95215 (209)463-5811 <br /> r 5. Tramponer I Company Nama r 6. US EPA ID Number C. Sbre Tranparter's ID[Reserve .f <br /> h <br /> 0 219t CFN TILAR f ENQ 0 0 0 0 5 2 8 0 3 D. Transp.ritses Phone <br /> co <br /> m 7. Transporter 2 Company Nome — B. US EPA ID Number E. State Transported,ID JR..,. .1 <br /> �a s Z-74-y.✓.t //A/ � e P( Q a O O 6 Z O F. Tran,wlcr's Phone g Al" / <br /> �Q bbftHj.NVfj&Abjakjk r 33Ce ACif.M{fl US EPA ID Number G. ShM1 Fxi ity,ID <br /> LnE Z 20245 777H AVER SoU H <br /> M3BTP, WA 98032 9 9 1 2 8 1 7 6 j H. Fac'.Phone <br /> (253) 872-8030 <br /> NQ I1. UB DOT Descri M1 I din Proper Shi Name,Hazard Class,and ID Number 12. Camels. 13. Total 14. Unit <br /> V p on(inc u g P pping 1 No. T Qu.sHty W0.1 1. Waste Number <br /> RQa'1A8T8 MEC ACID SOLMON 8611755 PBII 100112) 8860541 sale 723 <br /> 3 E D F O I G EPA/Other <br /> o N <br /> CO E Stare 331 <br /> CN R EPA/Other <br /> T "DON-ICU 881/16065 81SYS SOLID Stare 181 <br /> pm O <br /> \)W R aj� D F I a p EPA/Othm <br /> d.801-8011 IA111000S BASTE LIQOI6 State 726 <br /> �Z <br /> V D F G EPA/Other <br /> y0101 CDoan <br /> OZ 8) 9MI6fB i301iP'�'CBiO�'IIt88m'91fH B (1) h)-3t59Ye=1/-788 -SPUT'- K. H,ndrn9CodnkrwnrosListed Above <br /> H 811HHN--M9 (4) c) 122155-88 - SPENT BUD My - LPI1 (1) d) 115777-12 - 'a' ` 5 b. <br /> NICKEL SQLPATI - IAHB (2) <br /> Q <br /> 3 d. Ib <br /> 0 is eal Handlin Insnvdiom and Addnionaunkrmnrnr •I +v - <br /> 18As� ciPROPS P�OT6CTITS CLOT=. 81816®1CT RESPONSE PWKK (811) 567-7455. <br /> Z <br /> w <br /> M 3 <br /> Q16. GENERATOR'S CERTIFICATION: Ihervby declare that the contents of this consiggnment are fully and accurately described a have by praper,Hpping nameand era domified,packed, <br /> U marked,and labeled,and are in all respads in proper condition for Iranspod Isy highway according la applicable international and notional govmnment regukfiom. <br /> i <br /> If I am a large q c"'O ...etc r,I certify that I have o program in place to reduce the volume and toxicity of waste oneroted to the d <br /> H pre<.,.61e and Btat lave elected the racfico6le method of trwhnwl,,tor S ogres have determined to be ecanomiwllyy <br /> p age,or disposal currently ay.if.61.to me which minimum the present amt future threat to human beat <br /> and Iha environment;OR,if I am a small quonlily generator,I have made a good kith Joe to mmimixe my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> > Pn Name Signa a Monllt Da Ywr <br /> Z '� r� .+ c �1Z� a <br /> su 1 V. Trans arrer 1 Acknawled ement of Receipt of Materiab <br /> U R <br /> s°Cy A Prin /Typed Name Si naNte <br /> R / 1 8 / Month Day' Year <br /> O8 18. Tram nm 2Acknowld emwrof Recai ro Materials <br /> It Ninled/Typed Name Sig.'tatun - Meth Do Y <br /> 9 DA <br /> U F I . Discrepancy Indication Spew _ <br /> Z A <br /> C <br /> I <br /> L <br /> [ 20. Pvcii Owner oro afar Cedific on Of rwei loF hazordon materials covmed6 this nifesleuept can fed int <br /> T PH /Typed Name Signwure Month Day Year <br /> - <br /> If <br /> C9) 0 5 <br /> DO NOT WRITE BELOW THIS LINE S. <br /> yap <br /> DTSC 8022A 11/99) White: TSOF SE.NDAW 1gPpfqgp4qWITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br /> vr, w�w Qj. as,ii' <br />