Laserfiche WebLink
State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30.9 [ See Instructions on back of le 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(I -pitchy riter. 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 <br /> is not required by Federal law. <br /> - - i of <br /> 3. Generators Name and Mailing Address A. State Manifest Document Number <br /> LO <br /> n <br /> O -- •- M1 B. State Generator's ID <br /> LO 4 Generators Phone ( <br /> LO 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> 00 <br /> - �"'•- .,.id�, i.i• �� a �..�!": r5D. Transporter's Phone <br /> ao <br /> 8"y'_ 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved] <br /> u Q F. Transporter's Phone - <br /> J V 9. Designated Facility Name and Site Addre s 10. US EPA ID Number G. State Facility's ID <br /> ce "�•�'� '"'' H. Facility's Phone <br /> �J <br /> Q 12. Containers 13. Total 14. Unit <br /> V 1 1. US DOT Description(including Proper Shi 3ping Name,Hazard Class,and ID Number) <br /> No, Type Quantity .Wt/Vol I. Waste Number <br /> 't' •;. State ., <br /> �' t i1.:tL'/....iw� �k9"Yv.➢ 7`�.�:f:,-.:}� ✓„+?"'{7 �-•�^ 1 i�7�i xw .:' .. .. <br /> 3 E ? EPA/Other <br /> b <br /> 0 Nle_. <br /> O N .-�+.. i' - State <br /> CcoE nT� w i0.". ,�3N " 3"Ji:�€:. tiluw a:"1i::rj <br /> -4 R 1 EPA/Other <br /> C14 A „ -: <br /> c. <br /> T state <br /> ao O <br /> R EPA/Other, <br /> tw— d' State <br /> Z <br /> w <br /> V EPA/Other <br /> LU <br /> N J. Additional Descriptions for Materials Listed bove K. Handling Codes for Wastes Listed Above <br /> a b <br /> LU <br /> oc <br /> J <br /> C. d. <br /> Q <br /> Z 15. Special Handling Instructions and Addition I Information <br /> O .�...: T-;- i- <br /> Z CCNhVT f.sO.'.": s+ 4 i=. 1,t 4:. 9 <br /> 11 <br /> W 3= w.1 .G_ TW�� ' <br /> _ <br /> F— <br /> 16. GENERATOR's CERTIFICATION: I hereby eclare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Q marked,and labeled,and are in all respe is in proper condition for transport by highway according to applicable international and national government regulations. <br /> V <br /> If I am a large quantity generator,I certi that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> V) practicable and that I have selected the pr cticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small uantity generator,I have made a good faith effort to;minimize my waste generation and select,the best waste management method that is <br /> available to me and that I can afford. <br /> VPrinted/Typed Name Signature Month Day Year <br /> 0 T 17. Trans orter 1 Acknowledgement of Receipt WiMaterials -- <br /> R <br /> W A Printed/Typed game Signature a <br /> N 9 y:T t Month Day Year <br /> EL8 18. Transporter 2 Acknowledgement of Receipt f Materials <br /> T Printed/Typed Name Signature Month Day Year <br /> w E <br /> N R <br /> Q <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> L <br /> 1 20. Facility Owner or Operator Certification of ecei f of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99( <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />