|
Enveranmoval Protection Agency See Instructions on back of ^age 6. Department of Taut Substances Con+ro
<br /> ,OA No 2050-0079(Expires 9 20 991 Soeranento Califorslo
<br /> 9f`e. fwm dttsegned for rose on.lois!l2 pt)eh)r iter
<br /> 1 ciorierolor f US EPA ID No Manifest Document No 2 Page I Information in the shaded areas
<br /> UNIFORM HAZARDOUSes nw requited by Federal law
<br /> WASTE MANIFEST d
<br /> Ai f>a<4 A�Vnibe t, r
<br /> Genwalor's Nam and MadutgnnAcl&ess Q L p 1 ,_ ' � ., t•, „r
<br /> 5tof�K�ol� ✓r1 0 Av-a,�%*6A J+,4Qrsi1 to\1`1�\I �r}'i l� f� 4}�y?tee ' t'� r
<br /> �. ��y}rrir�v+l + rcl 0 y 1It
<br /> rF S'
<br /> in 4 CeneraWriihdeTI'�� 1� ,,i.1 r�M a _ I
<br /> t .y, 4t:aA
<br /> t*s S Tronspwter I Com 6 US EPA ID Number
<br /> S r ',�s .l qr • .r ,,•. [.
<br /> fIN-1 ~ 4r r
<br /> Q \� c
<br /> W 8 US EPA 10 Number u '
<br /> _ 7 Tronspwler 2 Company Name � r tine �
<br /> 9 Deugnwed Fouhy Nome and 5iie Address l0 US EPA ID Number `j
<br /> 1 a RAM4S ENVIRONMENTAL SERVICES
<br /> z 1515 S0UT1J RIVER ROAD, WEST SACRAMENTO, CA 95691
<br /> 1°` i
<br /> o r
<br /> 1 12 Container 17 Total 14 crus
<br /> 11 US DOT Description Imcludeng Proper Shipping Name,hazard Clow,and ID Num6erl No T WI/Yd I:Y
<br /> I'V [Srtfla V j
<br /> 1 Z
<br /> � IaoN 0 — r
<br /> 3 E l
<br /> ti ret.
<br /> ago Eq, •fir
<br /> . ,
<br /> Q A e �T
<br /> ca T Sfly/ l
<br /> iso R n.,Cd $1011114ky,
<br /> s
<br /> N ;
<br /> sit d ,' 1,[i' ''
<br /> Z
<br /> W f f [
<br /> IJ T K Hard uv Codd for woos l+pw Aba.a,
<br /> w ,tr On Iar inti A a..KY s, 4. r .^r:w L f';f 'I 5"1 ` , S [', i 7 [ , i .44 S'[. 'l}A
<br /> ,rfj+jer� F', 1. ���r„t.tR„ r.: r 11r ! \Y ti! 'S�� ii tlrc
<br /> -gin .s 'T+i Rl`�IF vI�' y r'e,1 i>�T tfi L e S� �.�/� Wer pit�� ,*'tkr�'�;rti [rW r �rt'`e�i _ ,a i �� 'al's., f e
<br /> {�[�' Msd't 1'L�° r• 4,Sr�]_ 1 f�ra er s }�'1 fr+•�?� y �3�1` �'�w.. ,"b 1 ? 1' ...rKn ,•
<br /> f ��x �y r S�{' r r r 1;74y*}� 1� !'• a' Iyf 1 f! ��aYi h t�y 1,Jr p� C [.. 1 v7t r r
<br /> "Vey
<br /> w�'�rrx'
<br /> �Q.+ 'T 1,{ 9fsr s +•i D�!�aC1n'rfk,.'s•u)ti' +'ctYS{ •Y4'{�[t'�j'aS� S A11111 a„
<br /> �sa -f.�SZr.�ilei► ,
<br /> Z
<br /> O 15 SpecialInstructions Handling Instctions and Addyy ilionol Information L 4. ; IDs i
<br /> J P` 1
<br /> a HANDLERS BE 40 HOUR OSTIA/SARA TRAINED
<br /> zUj AND USE NIOS11 APPROVO) PIT.
<br /> x A
<br /> r pocked,
<br /> � 16 "MltATQj,S CERTIfICA1loN I hereby declare Ilsat the contenh of 4h[s con�gnment ore lolly and occurolelrr describednjo abovs 6y proper shipping Home and are do stlud,
<br /> �< marked,and labeled,and we in all respects in proper condition for Transport by highway according to appl[cable tnlunatianol and aal[ona{gowrnmenl regulations
<br /> u I am a large quinti generator,I cerhly That I have a program+n plot:to reduce the volume and Toxicity of waste generated 10 the degree I hove determined to be ecotiomeeall
<br /> y ap
<br /> h proebc”and that I Trove selected IM practicable method of treolment storage or disposal currently avorlable to me wh[ch mmemrtes Tia present and Fwura Ifueot to human th
<br /> and Ilse omnranmerJ,OR.of I am a small quantity owwrolor,j hove mode a good faith effort to m[n[m,ze my wash generation and select the best wasle management molls that u
<br /> ac available to me and that 1 can afford
<br /> O Printed ped Name Signaler Months,. Day �rar
<br /> >- yyyy ./ S G
<br /> U L'l•R cC
<br /> su 1 17 Transporter I Acknowled emenl of Receipt of Materials
<br /> tY y hmted/Typed Name S,gnalure , month Day tear
<br /> r
<br /> � s
<br /> P
<br /> O 4t ! tasansA IA
<br /> IAA ter 2 Ac Howled einem of Recee t of renals M0n4h Day Year
<br /> Pred/Typed Name Signoture
<br /> N f
<br /> r
<br /> la.J 19 Discrepancy Indication Space
<br /> Z F
<br /> .- A
<br /> C
<br /> I
<br /> 20 Facile Owner or Operator Cerhfneahon of rices 1 of hosordous materials co.ered b this maafest exce t as no4ed m Item 19
<br /> T Punl>,r�11y}Nd NnhIM Slunul+uli Mnnfh pay Yutr
<br /> r
<br /> DO NOT WRITE BELOW THIS LINE.
<br /> DTSC 9022A 14/971 Yellow GENERATOR RETAINS
<br /> EPA 1700•-22
<br />
|