Laserfiche WebLink
Stole of California--Environmental Protection Agency } N• ., <br /> Form Approved OMB No.2050-0039(Expires 9.30-96) See Instructions on boek,..Opage 6. Department of Toxic Substances Conirc <br /> Please print or type. Form designed for use on elite(f2pi'ypewriter. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA tD No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST r y� rr c�6 is trot required by Federarlaw. <br /> 01 <br /> 3. Genrtr�lp y Nam11andJ�i Piling Address - ^ r, ; A. SlateQQManifes!Doeumerst Number m <br /> 40 V <br /> `'" : �• f.>: rr11R 1 95895155 <br /> N an thcdirtrl_ S'cs � �} rC•f?4 B. State GeneralorslD <br /> C9 4. Generator's Phone ( i �.r rx i{'-.:-f _ i H Y � 6 (1121 73 <br /> 0 5. Transporter 1 Company Name 6. US EPA ID Number CI State Transporler's 1D <br /> 00 <br /> >" C I:s C 4Z ? ',1.^. r l r -. 1;5 s r, iy r, ,•'i r� c �. t ' D: Traporter s Phons <br /> ns <br /> J <br /> J 7. Transporter 2 Com <br /> Q Po an Name Company 8. US EPA ID Number E. State Tranaporterrs ID <br /> a <br /> F- Trcmpoftei:Phone <br /> Z 9. Designated Facility Name and Site Address 10. US EPA ID Number Ca.'"state Fociliy's'ID <br /> -t-J.oc Etivi rmlrk7.rt' _a l <br /> -H. Facility's Phone <br /> %Q <br /> Ea F'A .iif:.c'. :34.s:. � ) Ct � t � 2 F �, � (4 5)324-��i38 <br /> cn,u - <br /> i"" 11. US DOT Dewi tion(including Proper Shi m Name, Hazard Class,and ID Number) 12. Containers 13- Total 14. Unit - <br /> ,,,y,r�_ p (� 9Shipping <br /> No. T Ouantity Wt/Vol I. Waste Number <br /> °,�= o. Stomp, <br /> ~ RO Lgai -'t s-IaTam -1-e ilr{t.t :?, Yr. it wi.tie L1� <br /> 3 <br /> C14E ', (�rvi�7_ . I E) [A)(Ii DO 1. "1 s T a f EP fxJU <br /> co N b' State <br /> v E <br /> I R EPA/Ofher <br /> o A <br /> 00 T c State. <br /> O <br /> R ERAJOefiar::' <br /> LU <br /> t- <br /> d. <br /> w C rl .kI _ <br /> �(.>'Ti7-G •3C t r i 1 Sfgte: . <br /> U 1 <br /> 11.t <br /> C7A jOTher' <br /> V) <br /> Z J- AdcRtionah ascriptiops or'Nlnferiafs�LhtedAboge <br /> 0 : K. Handling Codes far VVasfes Lested Above <br /> � Wates' 87� - 9r7% (IIA' DM) <br /> . a. b. <br /> a Petroleum Hydrocarbons 3% to 20%. <br /> a Solid 0% - 3% t . C. a. <br /> Z <br /> O 15. Special Handling Instructions and Additional Information <br /> a -''e4t qlo-ves and f ace ��T"f+`Ect. .:�r; 2.4 Hour Ehezgent <br /> Z <br /> 1.-800-233-062:3 <br /> u.t <br /> F LI-Levron E:nter:rerl,ry Irlf o. <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <br /> JIf I am a large quantify generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> a 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 /> V1 threat to human health and the environment;OR, if 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. 7 c <br /> 0 n d/Tr Z�v L_1/crcv�{lc . iMonth Day Aear <br /> U AS(U <br /> Trans rter 'Acknowledgement of Receipt of Materials / - <br /> (7 FPrinted/Typed Name _ .-y SignatureO, Month Da� 3 ear <br /> Ix X r <br /> WTrans otter 2 Acknowledgement of Receipt of Materials <br /> Month Day Year <br /> _T <br /> U_ T Printed/Typed Name Signature <br /> O E <br /> p <br /> N19. Discrepancy Indication Space <br /> Q F <br /> V A <br /> Z C <br /> I <br /> t <br /> 20. Focil' Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name SignaNre Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE, <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> OTSC•8022A (1/95) To: P.U. Box 400, Sacramento, CA 95812-0400 <br /> EPA 8700=22 <br />