Laserfiche WebLink
State of California—Environmental Protection Agen -9-31 1 .1 See Instructions back of a 6. <br /> p . 3 ons on acpage Department of Toxic Substances Control <br /> ' Please pnnf'orrtype. Form designed For use on elif (12-pitch)typewriter. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST C ATC'8 }`X 6 4'.'2 689t:`". is not required by Federal low. <br /> of <br /> 3. Generator's Name and Mailing Addr,ss ]'';?i:� ;(,; ],�) 1„,.]„-, A. State Manifest Document Number <br /> PID BAY. 15095a0 ��c)L:�ON 23510404 <br /> in >AN i•{�c{"i1_N C A tJ 45);".3 051 5 B. State Generator's ID <br /> n A. Generator's Phone( 212t9' 4 7 4—40 1.4 <br /> CV 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved] <br /> LO <br /> cp <br /> cp ::is'"a]''r-T`{--KL_EEt4 SY'S EMS, INC .,1..Y )��'l a�^' D. Transporter's Phone <br /> 669-57-40 <br /> tl <br /> T "- 7: Transpdrte'r'2 Company Name - -' -""- _' -- `-- 8 -US EPA ID Number-- - - - - E:-State Trcrosporter's ID fReserved:]-- <br /> �^ I <br /> ,CDQ F. Transporter's Phone <br /> U 9. DGs' a e acili N e and Site t e s 7 1 T--O 'J- 10. US EPA ID Number G. State Facili 's ID <br /> C)-Ice +_i�tr �r�—�; fis SY a MS INC' ;��00C,6'39' D <br /> `RC150 L=ip`,;._IDA BLVD c. <br /> �a' SAL.TDA Cri 95366 CAT00();`_.s 1:3 9 6.S H. Facility's Phone <br /> C =i 12. Containers 13. Total 14. Unit <br /> Q 11. US DOT Description(including Proper hipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> Z a. State <br /> = USED CLE�ANIN COMPOUNDS., N. O. I. E. N. <br /> ]_,I OU I D (NOT 1JSD IT OR USEPAi REGULATED) EPA/Other <br /> 3 G W_t k+I i 1.;5 PARTS W S HER SOLUTION (S- 3�#GAL_) Z — `I 0 <br /> Nb. State <br /> CD E <br /> co R EPA/Other <br /> v A <br /> o T c. <br /> State <br /> oD R EPA/Other <br /> ac <br /> Lu d. State <br /> ZZ <br /> U <br /> EPA/011ier ` <br /> w f <br /> n J. Additional Descriptions for Materials List d Above K. Handling Codes for Wastes Listed Above <br /> Z <br /> a. b. <br /> Lu <br /> c <br /> c. d. t <br /> Q <br /> Z 15 <br /> t <br /> L-.s P.:e_crriP[.�lrtdll, g.lastr R r.r C) <br /> _ f _ i'_',j t_! :-74 _'4dadFdi 1n lnfp�plgn <br /> ro l' gY ?tHR <br /> ZS A 941. G <br /> � ITE' 220E 3 M.ii_E <br /> j} <br /> RG' STOCILECiN <br /> 16. GENERATOR'S CERTIFICATION: I here y declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> I V marked,and labeled,and are in all res ects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantity generator,I ce tify that I have a pro ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> hpracticable and that I have selected the practicable method of treatment,storage,or disposal currently availa�ble to me ich minimizes the preset and future threat to human health <br /> and the environment;OR,if I am a sm P quantity generator,I have made a good faith effort to minimize/tny waste ge eration and select the est waste management method that is <br /> available to me and that I con afford. // <br /> } Printed/T ped Name Signature Month Day Year <br /> Luo TR 17. Transporter 1 Acknowledgement of Recelptof'Materials <br /> oc A Printed/Typed Name.' Signature . Month Day Year <br /> uj <br /> Lu P <br /> u.. A18. runs orter 2 Acknowledgement of Receipt of Materials <br /> 0 R Printed/Typed ed Name , nature <br /> T YP 9 -_. .. .. .Mont _ Day__. ._Year <br /> Lu E <br /> A <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> IFacili Owper or O ecator Certification 'Ie ei t of hazardous materials<ov ed thilmanife t except as no dkn Item 19, <br /> T <br /> in Typed lame Syn urea r / Month Day Yeo <br /> r i . <br /> DO NOT WRITE BELOW TH LINE. <br /> r� <br /> 1 Yellow: TSDF SENDS THIS COPY G ATOR WITHIN 30 DAYS. <br /> r <br /> L(�4 JUN 18 f}M2,25 (Generators who submit hazard waste foWtERE('�.7,',te,DTSC 7022A0— (1/99[ produce completed copy of�chi�/9Q6��anri 30days.) <br /> EPA 8700-22 V � iii/// <br /> t <br />