Laserfiche WebLink
State of Colifamia--Fm^ro*"^^mal Protection Agency SQQ Instruttions;on back of page O. ❑epartmen+o. +o.R�.���••�-• <br /> Form Approved OMB No.2050•-0039(Expires 9.30.91) Satramenro:Caiifom a I <br /> Please prior or yae• Farm designed for we on elite(1SpitcF I Information in the shaded areas <br /> .tor'S US EPA 10 No. Manifest Docume 2- Page 1 a <br /> UNIFORM HAZARDOUS is oar required by Federal law. I <br /> WASTE MANIFEST CIA I C O Q 17 it <br /> j I I I I I #' of <br /> A. Stt ftr Marifest Document Number '� O f 0 <br /> 3. Genera,ar's Name and Mailing Address NE uTy d,t.. T,�,i,�y. N: _ -'- 921 <br /> 5 _. <br /> �� 9_ state Generator's ID <br /> r �Rr4C �S3 7d I: <br /> ;ter <br /> A. Generator's Phone '•S Ivy ) 7 - 7 t re's 10 ' <br /> C- State Trdnspost <br /> co 6. US EPA 10 Number - - <br /> O 5. Transporter 1 Company Name <br /> porter`s Phone <br /> O D_-7raev C/ <br /> E.�-V"d GI.91 I �I ItoI�I - <br /> 8. US EPA 10 Number E.53aro Trrmsporfq{s ID <br /> 1 7. Transporter 2 Company Name - <br /> Ii I I F.'.Tronsportrx s Phone y <br /> 10. US EPA ID Number <br /> :G..:State fadlitl/s ID <br /> Q 9. Designated Facility Name and Site Address - r <br /> I <br /> H_.F r ': - <br /> 0 /Oar- <br /> �� � r <br /> Q I <br /> 13. Total Id, Unit r <br /> 12. Cmstainen A <br /> V vae Quantity Wt/Val <br /> � z.!<�"W astt Qe <br /> 11. US DOT Description(including Proper Shipping Name.Hazard Class.and ID Number) T Na I <br /> a• N07t1 RGt2A /��iz�,eQpcls Rs%�� a�a :.._ � ;_ <br /> U (.WRT� �rasc1rNG� I I 13 �LZ {� +�l. f, <br /> G �. .,ten- - >v. <br /> ri £ : <br /> b. <br /> ca E <br /> ca II _ <br /> o T <br /> EPs4af <br /> ULU <br /> Ln <br /> - <br /> LU <br /> r' <br /> eO _ _ . <br /> Z 15. Special Handling lnstrucfians and Additional Information -y r� Jl J <br /> ° r ld Nr-fc/ /r'ellgled- � i 4�0 <br /> ���E.�6E.uC/ 39-2 y <br /> Z �4/ f/,Z �. �.2�r NC /fix jS�arrsE C.r{ ,rf.! TEL . !re 47 <br /> W fo W G LI nI F <br /> ZZr <br /> �r lir <br /> r= <br /> 16. GENE ATO 'S CERTiFfCAT10N: I hereby declare rfrar the[o of the[onsignmert aro fu and accurately described abate by proper snipping name and are Classified, <br /> Q <br /> pocked,marked,and labeled,and ore in all respec-n in proper condition for transport by highway according to applicable federalr slate and international laws. <br /> U <br /> If 1 am a large quantity generator, t certify that I hare, a program in place to reduce tfi<valume and taxiciN of waste generated to the degree I have determined to le, <br /> economically practicable and that I have selected the practicable method of treatment,storage.or disposal currently avoilabie to me which minimizes the present and future <br /> threat to human health and the environment:OR, if I am a small quantify generator, 1 have made a good Faith effort to minimize <br /> N my waste generation and select the hest <br /> n <br /> 6-aste mans ement method that is available to me and!fiat I can afford. v or <br /> tz I sig Month Day <br /> O yped Name/ �Q iCr c r <br /> V r 17. Transporter i Acknowfedaetnent of Receiot of Materials <br /> Z u I Month Day Year <br /> Su red/T ped Name I S'gn° e <br /> O N y 11 QI I-3 <br /> s 9 <br /> :u <br /> . <br /> 8 i8. Transporter 2 Acknowi<dGemenr of Knot of Materials t <br /> U.1r <br /> T Printed/Typed N i r I Sig: .V ;r�tied t `�'r.ti j month Day Year <br /> �$ �d e, at E <br /> O <br /> WI 19. Dixre Indication Space <br /> � , <br /> Q F <br /> r//n <br /> Z_ -�� <br /> 20. Focility Owner or Qacrater Certificprion o recti a of hazardous materi covered by n mcnifest except as noted in nein 19.1 <br /> T ' to /Ty Name Sigrtamre % Mantra Day Year <br /> J/ DO NOT WRITE BELOW THIS LINE. <br /> OTSC 8022A (7/92) <br /> EPA 8700-22 <br /> 3 ` <br />