Laserfiche WebLink
Stale or Cul iiornia—E,Aronn:entcl Proiection Acency -I� " r' <br /> 588 In5si'uCJans O'il r.7C>C!( 4U 7 2.6, De?crlmentcfTaxicSubslcnces.Cont: r <br /> Form Appro d Oma No 2030-0039(Expires 9-30-99, t, 9 <br /> Please printoc t,rpe.. Form designed'for use en elite 1)2-pikc l typ_Nn,er Sacramento,Cclifornic <br /> 1. Generc!o-.'s US EFA ID No. 'Document No. I 2. Page 1 fniornotion`in the shode'd areas <br /> USI IFORM HAZARDOUS 5 is not required by Federaf Icw. <br /> WASTE MANIFEST I I I I 11 i or` <br /> 3. Generorar's.Name cnd Mcil`ing Andress kIkI A '�rela`hon est Doc ent y m6 r --+. �- s� v :- <br /> _ r <br /> i, <br /> O ; B ora e. en rotor zID y <br /> +�t5 d: Generator's;Phone ( <br /> :._< <br /> I � Transporter 1 Company Ncme -6 US c?A 1D Nun6e C Slcre rran speriers ID(Reserved] <br /> I <br /> �. Irco <br /> ons par er s PSore <br /> rn- � 1-/ Trc.sporter 2 Comp any Name .. 8 US EPA iD Number e r Ste re Transporters D[Reservea I _ <br /> L 77 <br /> Q n F Iransoor ers Phone <br /> IIIII111 I1 ` <br /> s U .9 Des.gncted Fauhty Name and Site Address 10, US EPAJD Number , G Sfa e-Fac hty s ID <br /> Z i <br /> � h Fcbrrty s Phone -= <br /> r � 1 <br /> st qQ + 12. Containers I 13. Tonal 14 Unit I _ <br /> ....aU 11. US DOT Description(including Proper Shipping Neme,Nezard Class,and 10 Num6eri - <br /> No. I Type Qucnrily WI/Vol I .Was�e1 Num per <br /> slot <br /> e <br /> 7 C EPA/Other I <br /> - - r <br /> ON S. I State <br /> a 1 <br /> co E <br /> R I I I I 1 1 1 EaA/Other --i. 1 <br /> � A c State <br /> p 0 <br /> R EPA/Other <br /> H <br /> EPA/Other <br /> I EIII <br /> I <br /> `"— -.'1 AYiart anal De anal ons for Mcre pals Erslea Aha e- - K Ncnd :r <br /> L {Ina Coaes,cr Wnsteslurea A6ave <br /> Lu <br /> d 15. Special Na ahng In ructions and Addlianel inFermotion <br /> F— <br /> Z a <br /> ul <br /> 16. GENERATOR'S CERTi FiCATIO N: I hereby declare that the cont—is or this can sig nm en ore bully and ccc Ira tel described above 6t'proper shipoina name and a`re classified,pac!ced, <br /> U marked,cnd lo6eled,and are'rn all respects in proper condifion for 1—sport by highway eccorcing to applicable internctionai cnd nolienci government reg'olalians. - <br /> „ I <br /> I IF I am a Ecrge gvpnhify aenercfor,I-'certify that I hove a program in piece to reduce the voiu .e and Foxr ity.'or waste generoted-to the degreea have Beter�mirted ro 6e economically <br /> i pracfica6fe and That I have ielec ea the prcOicoble method 61 Ireaimenh,shorage,or ctispcsck curn:nrfy nvancble to me whirr'minimizes the present and future threat to human health <br /> { and the environment;OR, i,I cm psmail quantity ceneretor,I hove made a eood Faith effort to mini ize my waste generation and select'r4ie best waste management method that is <br /> available to me and Ihot i can offend. <br /> O Pnn_ted/yoed Name r a S n t I r s <br /> C C u e <br /> Month, 0ey Ye <br /> 5 C.7 T 17. Transporter 1 Acknowfedcement cf.Receinr of Materials <br /> 1 w k P intcd/t/ped_ e , <br /> N Day, •� <br /> - wear <br /> 3 t ,'I "r.h i I - r ww;� <br /> w 1 rII <br /> 18. Transcooer 2 Aclnawleacerna et Receipl of Materials a <br /> O. R Srenciure h <br /> T Printed/Typed Nf ire I <br /> �Ye <br /> u7 <br /> Mcn� Day <br /> a 'DiI I <br /> U ;:l'9 sr[epcncyIndicctioir;Spaee -. •, <br /> Z A ] <br /> C <br /> 20. FccihF Owner or Operator Ce.dricarioh of re._6t of hczardcus meter cls covered by this mani,es,_xc_pt cs nope_m It n: 19, <br /> 'T Prinied/Typed Name Sicnctvre _ Monlh Day Year <br /> y <br /> DO NOT WRITE BELOW TH[S LINE. <br /> f <br /> DISC 8022A '1/911, <br /> EPA 6700-22 . (ef'a.,. EN1: JOY p <br />