Laserfiche WebLink
State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9.30.99) See Instructions on back of page 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12•pitc' ewriter. <br /> Sacramento,California <br /> UNIFORM HAZARDOUS venerator's US EPA ID No. Manifest Document 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST C f ' is not required by Federal law. <br /> _ _ <br /> 3. Generator's Name and Mailing Address i t % I ;/ A. State Manifest Document Number <br /> � t. �- f < <� f ; _.,<-, 24978156 <br /> C 1 A4 <br /> C:4 ken t <br /> O - B. State Generator's ID <br /> A. Generator's Phone(/ y ) VJ <br /> CV 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID Reserved.) <br /> LO <br /> co <br /> .'N I D. Transporter's Phc <br /> ao 7. Trans ort4r 2 Company Name E. State Transporter's ID Reserved.) <br /> P P Y 8. US EPA ID Number <br /> LO <br /> J <br /> J <br /> F. Transports P ne <br /> Designated. rwLSil Adde�w.�. 10 )MPPA 1 r� f i G. 5 <br /> 00 <br /> =tea y---`'^'`�` j ! I'��.t��t y� ���, H. F <br /> acili s Phon <br /> PK <br /> U- 5� ail �� <br /> J ' <br /> Q ` tntainers 13. Total t <br /> V 11. US DOT Deuripti9�Opclud)n Proper Shipping Nam,Hazar/ C sd , h I b ) 14. Unit <br /> o. Type Quantify Wt/Vol I. Waste Number <br /> Z a { l•,' �' J ,.J State <br /> 3 G ��-,F t Y;��j✓�jif`�Y' 1 , , 1� /t 1 ,� J EPA/Other <br /> �i E <br /> O N b. State <br /> 00 <br /> 65 E <br /> N R EPA/Other <br /> v A <br /> o T c State <br /> w O <br /> R EPA/Other <br /> LU <br /> t— State <br /> Z <br /> w <br /> V <br /> EPA/Other <br /> LU <br /> Z J. Additional Descriptions for Materials Listed Above K. Handling Codes For Wastes Listed Above <br /> O <br /> a a. ' b. <br /> L <br /> LU <br /> d. <br /> Q <br /> 0 15. Special Handling Instructions and Additional Informai j <br /> W <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J <br /> J 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 economically <br /> Npracticable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> O <br /> available to me and that I can afford. <br /> >- f Printed/Typed Ne / Si natur <br /> p^] , ry g Month Day Year <br /> w <br /> R17. Trans o"Yrt' Acknowledgement of Rec i t of Materials <br /> NCf, <br /> Printed/Typed ed Npme ^ 1 <br /> `,, 11 g s / V __L[_ /.f Mon Day Year <br /> w YP ` % Signature J �'f //� <br /> si _;�"7 <br /> 0 18. Trans orter 2 Acknowled ement of Recei t of Materials r <br /> 0 T Printed/Typed Name Signature Month Day Year <br /> w E <br /> N R <br /> Q <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facili Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) <br /> EPA 8700-22 Yellow: GENERATOR RETA'VS <br />