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 i- <br /> Please print or type. Form designed for use on elite(12-pitr' rewriter. Sacramento,California <br /> Generator's US EPA ID No. Manifest Documet. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS v I� ,I is not required by Federal law. <br /> WASTE MANIFEST L �j . u of <br /> 9 /✓f 0 O,4� ���/`c / S A Stale.Mmifesl Document Nuashet <br /> 3. Generator's Name and Mallin Address � �/ e ' <br /> fl27252 <br /> B.Sraa Ci.n.tolaetnlD ',c t 1 <br /> d <br /> --r7•/ <br /> In 4. Generator's Phone ` <br /> - <br /> (V S. Transporter 1 Company Name 6. US EPA ID Number nn Eastat.Tronsportes'fitQ rt "�• ' <br /> TRIDENT TFtucKLlr�Es CAD 982 Q 4 3 i U D Tmnspq[Is f honra,,; r <br /> IlKill a, <br /> o <br /> aD 7. Transporter 2 Company Name 8. US EPA ID Number E.'Stat4:Tronspott«'�)D' <br /> Ef:T�ansp�ocF�i.Phone��, ;�•: t , <br /> V V gftW,0I(b'0WigNBpme and Site Address 10. US EPA ID Number G �+uK� +.r <br /> e sv. <br />'7Q 255 PARR BLVD '♦j- <br /> V ZqG Phone r: <br /> O RiCHiAGNO, CA 94601 CIA Q G G 9 4 o cid 3 9 F«tll J <br /> V Q I 12. Containers 13. Total 14. Unit <br /> lJ <br /> 11, US DOT Description(including Proper Shipping Nome,Hazard Class,and 10 Number( No. Type Quantity Wt/Vol •I.'Wash N` <br /> FE)RAGE TANK <br /> Efdf <br /> 0_ v J <br /> ..:� <br /> Non-RCRA hazardous waste solid TP P <br /> C�i E b. <br /> o N <br /> 00 <br /> to E <br /> 4 R <br /> C"! A C <br /> o T ,►rs�'^j <br /> co R r _r�[dlier <br /> a..• •�6i <br /> EPA,LU <br /> t*: <br /> J. Additional scpptions for Materials UstedAbow ^k}ks � K,I.}ots�Img Coda los Wastes LtsHd Above .8 x <br /> c,:TY. EMPTY STORAGE Te�NIttSX# '` -,, ^` - b . <br /> s 1.85 ORY rCE PER t o00 GI�1I.LU <br /> DRI$CAPACITY � "�� =� ' �P' r * ��; � •�. <br /> Zi7/ J . v <br /> O is i rat <br /> 24 Hour Emergency Telephone Number <br /> Z 124 Hour Emergency Contact: - ERG 171 <br /> LU - f <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 are classified,packed, <br /> U <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 /> J <br /> 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 degrr I hav�determined to be ecotsomically <br /> N practicable and that I hhove selected the practicable method o treatment,storage,or disposal currently available to me which minimizes the resent 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 wave management method that is <br /> available to me and that I can afford. <br /> OPrinted/Typed Name i , Signature r r Month Day Year <br /> tL T 1 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> —7 <br /> ac A I Prinled/Typed Name Si ur riAeath Day Year <br /> ,.t O 1 l 3 5 57 <br /> U- 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 T Printed/Typed Name Signature Month Day Year <br /> W - .�. - ♦ 1�eie <br /> V) E <br /> Q R <br /> V 19. Discrepancy Indication Space `y <br /> Z A <br /> C t, 1 <br /> I <br /> L <br /> l20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> TT <br /> Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (4/97) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />