Laserfiche WebLink
__4LEnwronmental Protection Agency <br /> '.ed 0M5 No 2050-0039(Expires 9 3494) See Instructions on back of page 6 <br /> R <br /> nrs,or type Farm designed for use ori elite(12-porch)typewraer Department of Toxic Substances Co, <br /> Sacramento Coliform. <br /> FORM HAZARDOUS I Generator's US EPA ID No Manifest Document No 2 Page 1 Information in the shaded areas <br /> ASTE MANIFEST is not required by Federal taw <br /> ofor s Name and Mailing Address — <br /> ar Inc. 525 West Th�.rd Streetd, CA 93230 <br /> or s Phone20 583-3247rter 1 Company Name <br /> 6 US EPA ID NumberOP ter 2 Company Name <br /> i U 8 U$EPA ID Number <br /> Z 9 Designated Facility Name and Site Address `r <br /> Q Z i0 US EPA ID Number <br /> 4' <br /> r--I0 A De,�enno/Kerdoon <br /> I T__4 2000 North A-lameda Street <br /> Uter , V�°"e <br /> I 00 Z 11�VS DOT Description(including Proper Shopping Name Hazard Class and ID Number) 12 CoMamers 13 Total 14 h Unit <br /> o No T Quantity Wt/Vol a <br /> 3 � <br /> o E Non--RCl2A Hazaa>ddus ,haste Liquid <br /> I ap N b <br /> co <br /> R <br /> TVAVI`r STREAM HAS BEEN QUALIFIED <br /> o a F i RECYt;LIN'/TREATMENT AT THE r <br /> 0 T ` DeMiENNO/KERDOON FACtUT11tt0f4MN, <br /> Ix R CALIFORNIA THIS FACILITY HAS THE NECESSARY <br /> ; r <br /> LU ITS TO UR WASTE STREAM AS <br /> t ` <br /> Z d9 <br /> U QUAUFIED OUR EPA NUMBER IS CAT080 <br /> dale <br /> LU f a» u <br /> Ln <br /> , EQA¢cKer €- <br /> p �li•°ybw�m ��.t?�fatGf n'r$1.40d Ab. }i <br /> q n rfi a A _ r K ffpdd{tnq Codes for Wast*Lstied,,*xa <br /> wa` b <br /> r pr'oprlatia protAaetive cloth <br /> r� <br /> Z r <br /> O 15 Special Handling Instructions and Additional Information <br /> ti <br /> Z Emergency Contact (209) 583-3247 ter. <br /> Guide Bool, x,27 Profile #17996 Site: Beacon Station #1-641z 1210 Last Nai=er Lane <br /> CA 95210 <br /> -+ 16 GENERATOR S CERTIFICATION I hereby declare that the contents of the 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 on proper condition for transport by highway according to applicable federof state and international laws <br /> V <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 have determined to be <br /> CL economically practicable and that 1 have selected the practicable method of treatment storage or disposal currently available to me which minimizes the present and future <br /> M threat to human health and the environment OR if I am a small quantity generator I have mad <br /> 1X waste to me and that I can e <br /> waste mono ement method that s afford illi effort to minimize my waste generation and select the best <br /> 0 Pri � / d ame � Signa e <br /> Month Day Year I <br /> V -�- <br /> Z TI r ns iter 1 Acknowled ement of Receo t of Materials ' <br /> J'. R <br /> Ue A grmted/Typed Name <br /> Signature <br /> w s / - t r 4Z <br /> Month Day Year i <br /> - l� J <br /> it18 Trans orter 2 Acknowledgement of Reeei Materials <br /> T Printed/Typed Name <br /> O a tLL Signature Month Day Year <br /> LU19 Discrepancy Indication Space <br /> a F <br /> V A <br /> Zi c <br /> I <br /> L <br /> 1 20 Faali Owner or OPeralor Certification of rete, t of hazardous materials covered b this manifest except as noted in Item 19 <br />. T Pnnted/Typed Name <br /> Y Signature Month Day Year <br /> ` r <br /> DO NOT WRITE BELOW THIS LINE <br /> r�r <br /> DTSC 8022A (7/92) Yellow TSDF SENDS TH45 COPY TO GENERATOR WITHIN 30 DAYS <br /> EPA 8700--22 (Generators who submit hazardous waste for transport out of state <br /> produce completed copy of this copy and send to DTSC within 30 days) <br />