Laserfiche WebLink
n , <br /> i <br /> $ 'Q 6. Deportment of Toxic Substances Control <br /> State of California---Erni—mental Protedjo�Agency Sed! InSltru CtlonS on Mack of Sacramento,California <br /> Form Approved OMB No.2056-0039 IF.6;,9-30-96} <br /> please print or type. Form designed/orus.on elire(12-pitch)ty Aer. Manifest Document No. 2- Page 1 Information in the shaded areas <br /> d 1. Generator's US EPA ID No. is not required by Federal law. <br /> UNIFORM HAZARDOUS } of <br /> WASTE MANIFEST +: 0 ri : <br /> A�State Matafest Document Number <br /> Mallin Address _ t-P.- ^•^•r � s : <br /> 3. Generator's Name and 9 - , �• _ - - til; ti <br /> �, r sl` - =� B. State Generator's ID t:- 't <br /> N <br /> h 4. C--1-10("Phone <br /> - <br /> C=;,State Transporters IDI: <br /> 00 6 US EPA ID Number R✓ i <br /> O• 5- Transporter 1 Company Name <br /> C? , D..Traruponier s /Ci n /^� <br /> £..State T <br /> 8. US EPA ID Number ransporters ID 'c' - a <br /> 7. Transporter 2 Company•Name <br /> F:'Transporter's Phone '_ <br /> j4 <br /> Q l0. US EPA ID Number G.RStafe,Facilty`51D < <br /> E Z 9. Designated Facility Name and Site Address - <br /> Y' 0 joT <br /> Facility's Phone ;r 1.G 1235-139 <br /> w U rs 13- Total 14. Unit .�e Quantify Wt/VoS I. WasteomI1. US DOT Description(including Proper Shipping Name.Hazard Ckass,and ID Number}G i!•i t . l <br /> E `"� <br /> 0 N b Stcft <br /> -a <br /> CO <br /> £PA/Other:.%, l <br /> R ,� I <br /> O State <br /> A <br /> o T r <br /> 00 <br /> Q £PAfOther, <br /> R r .9- <br /> lL State �'- <br /> Z d <br /> V EPA/OlEneri,r; a* <br /> r ` s' <br /> Eor Wastes l•nsed AboevK Handling Codes <br /> Mny]� iedAi, ]tO�os1 bpf <br /> O <br /> c pz <br /> w _nk(s) ve tin 1hPrtecirw <br /> LU _ <br /> !hs:Lv£ice PeIU> Oallo*> Capacity , - % C. <br /> a. . <br /> f <br /> 1 O 15 Special Handling Instructions and Additional Information <br /> QLf -•( f 1 Fl. J. <br /> Z <br /> W <br /> }- <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore fully and accurately described above by proper shipping name and are classified, <br /> Q packed,marked,and labeled,and are in alt respects in proper condition for transport by highway according to applicabte internotional and notional government regulations. <br /> U <br /> _ If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be <br /> 0. economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith elfort to minimize my waste generation and select the best <br /> I waste management method that is available to me and that I can afford. <br /> i Month Day Yee, <br /> O Printed/Typed Name Signature <br /> Z R 17. Trans orter 1 Acknowled ement of Receipt of Mcteriols <br /> t� Signature ' Month Day Year <br /> ur s Printed/Typed Name <br /> C p <br /> LU p 18. Trans iter 2 AcknowledLU <br /> email of Recei t of Materials Month Day Year <br /> U- Printed/Typed Name Signature <br /> o E <br /> R <br /> LU 19. Discrepancy Indication Space <br /> >n <br /> Q F <br /> U <br /> A <br /> Z C <br /> I <br /> L <br /> 20. Facili Owner or O rotor Certification of recei i of hazardous materials covered b this manifest except as noted in Item Month Day Year <br /> 7 Printed/Typed Name Signature <br /> Y <br /> I DO NOT WRITE BELOW THIS LINE. <br /> 3=i^-EkAIOk SENDS =Gf'Y T} DISC '+V i1HIN 30 DAYS- <br /> ; D75C'8022A I1/95} 4C-0 Sacramento, CA 95812-GaDO <br /> EPA 6706-77 <br />