Laserfiche WebLink
0 <br />a <br />C <br />l <br />U <br />u <br />LLn <br />LL <br />LL <br />LL <br />C <br />LL <br />Q <br />U <br />r. <br />State of Califomio—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 {Expires 9.30.99) <br />Please print or type. Form designed for use on elite f 12•pltc writer. <br />See Instructions on back of p06. <br />Deportment of Toxic Substances Control <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/991 White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 ` To: P.O. Box 3000, Sacramento, CA 95812 <br />Generator's US EPA ID No. Manifest Document No. <br />UNIFORM HAZARDOUSL'IAI <br />2. Page 1 <br />JacrOmanTO, California <br />Information in Ike shaded areas <br />WASTE MANIFEST <br />is not required by Federal law. <br />3. Generator's Name and Mailing Address <br />A. State Manifest Document Number <br />SAFEWAY <br />23 423101 <br />0 <br />V) <br />16900 West Schutte Road TRACY r.A M17S <br />B. slate Generator's ID <br />W) <br />A. Generator's Phone ( 209119334872 Curt rriQAie <br />N <br />h <br />5. Transporter 1 Compvny Name6. US EPA ID Number <br />C. State Transporter's ID[Reserved.j <br />CP <br />0 <br />EECOlogy Control 1ndUStrieS 3 inninii <br />R.F' 3 IS 2 3J L& 1 <br />D. Transporter's Phone <br />a7 <br />J <br />a9 ! <br />7. Transporter 2 Company Name S. US EPA ID Number <br />��� <br />E. State Transporter's ID [Reserved.) <br />J <br />Q <br />V <br />I <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />Q <br />ucrRiBicrieiv ilviuvivii <br />0 <br />2000 North AiaMeda Street <br />H. Facility's Phone . <br />J <br />Compton CA 90222 - - <br />-- — <br />- - - - <br />Q <br />V <br />11. US DOT Description (including Proper Shipping <br />P r g p ppin Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />IA. Unit <br />No. <br />Tye <br />Quantity <br />Wt Vol <br />1. Waste Number <br />Z <br />Nil I ct^r�® L.ih7d1?M I IC saleCTC' 1 <br />State <br />= <br />H <br />lnl IIR <br />s e,.ee r ays e. , s a vu a aswvv a o..v r s—�Lrw vry <br />3 G. <br />{petroleum hydrocarborls,Water} <br />'$'�' <br />s <br />+ <br />EPA/Other <br />E <br />. .!� <br />_ <br />i� <br />a N <br />so <br />Is. <br />state IN QN11— <br />E <br />y R <br />EPA/Other <br />et A <br />T <br />c. <br />State <br />Q <br />- R <br />EPA/Other <br />Y <br />d. <br />7 <br />u <br />Sloie <br />EPA/Other <br />U <br />• 1; Additional Descriptions for Materials Listed•Abovd "" <br />K. Handling Codes for Wastes Listed Above <br />1 <br />118) Profile Q35668sumps! w ash out (oily wraterj <br />p. b. <br />� <br />r <br />c <br />d. <br />[ <br />15. Special Handling Instructions and Additional Information ' <br />W --r Mro-er raatec ivi—a ®�i�i� � p�i"9s 9• aVhilla bow rilliF"isrn� Welrihta rr we%1sjm&Q nr® '3 i'1Y6PI►Vii'i'13t® 'd �i/Sii <br />I vs.e�. <br />'+ <br />emergen geigp lc�rae number ( 0 ) 32i -5479 (E+~I Dispatcher). EC6 � 243324 ,.,........�. ..w. <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, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to <br />applicable international and national government regulations. <br />i <br />! <br />i <br />If I am a large quantity generator, I certify that I have a pr ram in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economically <br />practicable and that I have selected the practicable method of treatment, storage, or disposal Curr vailable to me which minimizes the future human <br />present and threat to health <br />and fh environment; OR, if I am a smolt quantity generaror, I have made a g faith effort minim ze my waste generation and select the best waste management method that is <br />av ' to me and that 1 ca afford. <br />Printe /T ed Nome Signa rel I� rye <br />®ay ,yYneor <br />1 <br />R <br />17. Trans orter i Acknowled ement of of M erials <br />5 <br />Sign fay� Year <br />'(7 <br />0 <br />18. Transporter Ackn led ement of Receipt of Materials <br />R <br />E <br />Printed/Typed Nome <br />Si natu <br />8 <br />Month Day Year <br />R <br />F <br />19, Discrepancy Indicat"ion��V NTITDISCREPANCY GREATS! THAN 10% ARIA RE CIL D <br />C <br />WITH GENER�i0 8ANSPDRMR ON ITN_ .. <br />I <br />OF rl�- ?____GALLONS <br />E <br />—RECEIVED . <br />20. facili Owner or Operator Certification of receipt of hazardous materiols covered b this manifest exce t as noted in Item 19. <br />� <br />YPrinted/Typed <br />Name Signature <br />Month Day Year <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/991 White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 ` To: P.O. Box 3000, Sacramento, CA 95812 <br />