Laserfiche WebLink
State of California-Environmental Protection Age cy f"' :j--i„1 IL <br /> Farm App, ..e-oiatrNo.2050-0039(Expires 9- 0-99) Set IF15rFUCtI0I15 OFl bOC�C Of POSE b. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on eh a(12-pitch)typewriter. Sacramento,California <br /> UNIFORM HAZARDOU 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> i�:f <u t_J(,1 ,-�l t `f r�y('d r=J .j is not required by Federal law. <br /> WASTE MANIFEST of <br /> 3. Generator's Nome and Moiling Ad ressJ• F t`�-L fu 1=t-L- A. State Manifest Document Number <br /> 5095 R09, 3E00(j1,w 22884170 <br /> f, � ••'' B. State Generator's ID- <br /> ,.J:"f: 111' M,0 1Y D <br /> V) <br /> 4. Generator's Phone( 2t+*s7) 4­­ 4-4014% HIYy WI's 6 f 1 9r <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved] - <br /> o7 j_.!\.I F,I_E t:'N J S T.S:.t�i T XR 00 0J 1r3 04� <br /> 0 <br /> D. Transporter'sPhone <br /> o e60 669-5740 <br /> cp 7. Transporter 2 Company Name 8. US EPA ID Number E.-State Transporters ID[Reserved:}--- --•-- --- --- �{ <br /> , <br /> II _ Q F. Transporters Phone <br /> 1.�7 U C9�yD siynatetd Fqul�tysPlamr pndSile res er 1,�{.;'' 10. US EPA ID Number G. Statelp 'Lty' IF <br /> f > r �J7Y� f� LfS <br /> 00 Z 0;�0 �AL.IDA L�L:.1D <br /> O .r^AL DA 1.A 9536E C'.f":.Tt,�0�;_/,`•'A.968 H. Facility's Phone - I <br /> w 209 545-1011 <br /> 'I^t U 11. US DOT Description(including Prop r Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit - - <br /> `V 1�� No. Type Quantity Wt/Vol I. Waste Number <br /> Z ,�,BE' 1 -L.r_AN1.N �C)Mr-roti ,�;'G, 7 , State <br /> II { a f J. u. `t B. 3a. L1}`i G 1:34 <br /> i._ 1 k_I1D !i�iQ7 USD aI- �"IR i{CEPA RE'}_'1J1 AI'ED) <br /> G fti Of.[EOU PAP'S W -JI”ER .:f#Gr'M_) � ) / EPA/Other <br /> E <br /> o N b. State' <br /> m E <br /> <t R .EPA/Other <br /> v A <br /> o T <br /> .State <br /> oo O <br /> R EPA/Other - <br /> t- d. , .State ... <br /> Z <br /> Lu <br /> U [ 0lle: - <br /> w <br /> J. Additional Descriptions for Materials Li ted Above <br /> Z P - K. Handling Codes for Wastes Listed Above <br /> 0 1 b - <br /> n. a. <br /> oc c, d. <br /> Q <br /> Z <br /> }� <br /> M " <br /> : lad n nnd <br /> frt, w0-` ,a -n7 i 2A-HR <br /> Q <br /> Z <br /> w �a <br /> :_t _1 T E: 2,10'07 E L M i E R D STLit_I'°,1 of 1 <br /> 16 t GENERATOR'S CERTIFICATION: the by declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> < marked,and labeled,and are in all r spects in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <br /> If I am a large quantify generator,I rtify that I have a program in place toreducethe volume and toxicity of waste generated to the de ee 1 have determined to be economically <br /> practicable and that It-selected t e racticable method of treatment,storage,or disposal currently available o me which minimizes th present and Future threat to human health <br /> and the environment;OR,if I am a s all quantity generator,I have made a good faith effort to immize my w ste generation and selec the best waste management method that is <br /> fnl� available to me and that I can afford. <br /> Q s <br /> } Printed/Typed Name Signature Month Day Year <br /> w <br /> U1 T R 17. Transporter 1 Acknowled em nt F Re ei f of Materials <br /> wN Prince /T ed Name Signature -_ �'� Month Day Year <br /> w P C C 7 - r� 3 <br /> w 8 18. Transporter 2 Acknowled ement of RW`1 of Materials <br /> O RPrinted/T eMonth Day Year <br /> Printed/Typed <br /> N E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> L <br /> 1 2 . Fac lity Owner or Operator qLertificatioof ribceilpt of hazardous materials c4erecl)by this manifest except as n64cf in Item 19. <br /> T Pr me TT�ylped Na`Ine�J 1 //� Sig atu ,Y / ant y/, Da Year <br /> O NOT WRITE BELOW THIS LINE. . . <br /> Yellow: TSDF SENDS THIS COPY TO GE TOR WITHIN,30 DAYS. <br /> DTSC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br /> RECEIVED JUL 2 8 7093 <br /> i <br />