Laserfiche WebLink
State of California—Environmentol Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9.30-99) See Instructions on back of pa ���� Department of Toxic Substances Control <br />Please print or type. Form designed for use on elite f t 2-pikhj iter, 1 ` Sacramento, California <br />'1 <br />til <br />T-4 <br />J <br />Q <br />00 U <br />r <br />1401115-4 <br />ME <br />a <br />FW - <br />Z <br />w <br />U <br />Z <br />Q <br />N <br />LLQ <br />Z <br />C <br />H <br />Q <br />Z <br />J <br />J <br />CL <br />N <br />W <br />N <br />Q <br />U <br />iiia <br />DO NOT W IF�LINE. <br />White: T5 DF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 8022A (1/99) To: P.G. Box 3000, Sacramento, CA 95812 <br />EPA 8700-22 <br />UNIFORM HAZARDOUS <br />1 . Generator's US EPA ID No. Manifest Document No. <br />. Poge 1 <br />n <br />Information in the shaded areas <br />is not required by Federal low. <br />WASTE MANIFEST <br />_ <br />? dF 7 17-1Z I@ I5 <br />of ' <br />..3japersvr' _ eme and Mailing Address <br />A. Stofe Manifest Document Number �i�g}f ; <br />2 4.2 2 t7 51 <br />18900 West Schulte Road Tracv r&95379 <br />B. State Generator's ID - <br />4. Generator's Phone ( 209 X533 4936 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserved.] <br />Ecology Control IndustFleSD 9 8 2 0 3 P 1 j <br />D.: Tronsporter's Phone <br />7. Transporter 2 Company Nome 8. US EPA ID Number <br />E. State Transporter's ID (Reserved.) <br />F. Transporfer's Phone <br />�oo Desi ted Fa iht�,, N evand Sites pddr 10. US EPA ID Number <br />Di..r•.��ww•� •Ge•i� 9�s. G'wn{{i' <br />G- State facility's ID '. <br />- <br />'1 <br />•..1r{! vas r r.•CO vvt Y.-s.nv-Vrsctii s ubsuiy� <br />q"'� <br />� tJ <br />425 isis ave. _ _ _ <br />H.. Facility's <br />INGLEW000 CA 80301 0 i$ <br />1423 . �;1!33 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />Containers <br />Q Total <br />Quantify <br />14. Unit <br />Wt/Vol <br />I. Waste Number.,,'; <br />No <br />No <br />Type <br />,, �j � , ` p� ` {� <br />a. 000 R CRA S:fi+2+ Car'UOSS QAST � l J �'tt> <br />StaM�S Z <br />C3`i► c.N. C.�a1 c.3`.awa. C,a.-wb®w�TG <br />EPA/Other.,,.,.. <br />E <br />O L <br />P <br />pyt t <br />O <br />N <br />b <br />State <br />E <br />EPA/Other <br />R <br />I <br />c. <br />I <br />State ; <br />T <br />O <br />I <br />EPA/Other o. <br />R <br />d. <br />State <br />EPA/Other <br />Ji t' r <br />K. Handling Codes for Wastes <br />Listed Above <br />b. <br />c. <br />d.. <br />a�iS"41eeFi9+ fll6.fPs�diPlfli't6'Yi `�i'P"3i9�°191�'.a.4�rst uohilca FianAl'inn VU airihfa nr we%h irnaa nTa annrewirnata '?d lr.ln{ {r <br />sr �.wa• er•vEvw• r••vevvse.v ..v'.wstvse•r.•s •••sssw •ss•••wss••a,• eew•�•sw a.s •v•ew•.sv.a• ra•a w`r�v•v•s••sss•ar• ®-r •.ar w•e <br />emergency telephone number (800) 321-5479 (ECi Dispatcher). EGi jN 6243324 <br />s;t® SrrIlrsrneo-cama Sa manmratorS address <br />16. GENERATOR'S 'CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and one classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />if I am a large quantity generator, I certify that I hove a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />and that I hove selected the method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />practicable practicable <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 monagemew method that is <br />available to me and that I con afford. <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />c -- a" <br />b I q 11 3 o y <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />R <br />p <br />RS <br />Printed/Typed Nome <br />MA YL la 1AA f t- L (fIL— <br />SignaNre <br />144. yl'1 <br />Month Day Year <br />oil-/ 1/ 1110 <br />P <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of'Moterials <br />R <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered b this onifest ex t as n ed in Item 19. <br />T <br />Y <br />P ' /Typed Nomr� �.r� is <br />Signature <br />Mont Day Year <br />2 <br />1 C7vVZ /� <br />DO NOT W IF�LINE. <br />White: T5 DF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 8022A (1/99) To: P.G. Box 3000, Sacramento, CA 95812 <br />EPA 8700-22 <br />