Laserfiche WebLink
!. , <br />omia—Environmental Protection Agency <br />r See Instructions on back of <br />Form,Approw� CSMB No. 2050-0039 (Expires 9-30.94) <br />Please print or type. Form designed for use on elite (12 -pitch) r. <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. <br />WASTE MANIFEST A <br />3. Generator's Name and Mailing Address <br />to AJC <br />C4 <br />4. Gen"erator's Phone (�� ` 7 �4 , r. '� <br />i <br />e� 5. Transporter 1 Company Name r 6. US EPA ID Number <br />4;�i,�"JROAJMEKAL SERVICES <br />Al Di 9181016191 51 71 q t <br />j 7. Transporter 2 Company Name 8. US EPA ID Nun*er <br />Q <br />VZ 9. Designated Facility Name and Site Address 10. US EPA ID Number <br />�Z EVERCREEN 0141% r <br />T)O df i st€s�idi$� <br />QV Mwark CA 94HOCSD 19 18 10 18 18 1141118 <br />11. US DOT Description (including Proper Shi m Name, Hazard Class, and ID Number N Container <br />yl <br />hZ P• (• 9Shipping ) No. T <br />DEE <br />3 gq�aa��sa�gp ;gg q��q >� ; g �-g {�y <br />G - ,i�a.,n?"'t"Sias'td`21�c`$ZAR U A STE' LI FW 01 0 F i <br />Ci E <br />.: N b. <br />co E <br />R <br />A <br />T C. <br />00_ .® <br />a R <br />LU <br />Z <br />dUj <br />6• Department of Toxic Substances Control <br />Sacramento, California <br />2. Page 1 Information in the shaded areas <br />is not required by Federal law. <br />of <br />FIR <br />13. Total 1 14. Unit <br />Q <br />Z 15. S eciol Handling -Instructions and Additional Information <br />DOT ERG 31' WEAR PROTECTIVE EQUIPMEN <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br />packed, marked, and labeled, and are in all respects in proper.condifion for transport by highway according to applicable federal, state and international laws. <br />( U , <br />If I am a large quantity generator, I certify that I hove a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be, <br />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimises the present and future <br />t1 threat to human health 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 <br />N <br />waste management method that is available to me and that I can afford. <br />® Printed/Typed Na a Signature R` f Month Day Year <br />a �711 <br />Z T: 17. Transporter 1 Acknowledgement of Receipt of Materials <br />UJA Printed/Typed Name j / Signature 1 Month Day Year <br />�{ 0 18. Transporter 2 Acknowledgement of Receipt of Materials ' <br />tJ1 T Printed/Typed Name r Signature Month Day Year <br />i1: E <br />O R <br />N19. Discrepancy Indication Space <br />Q F <br />U A <br />Z C <br />C <br />_ t <br />1 20. FacilityOwner or Operator Certification of receipt 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 />f <br />� <br />DTSC 8022A (7/92) t 1 <br />EPA 8700-22\'x,: Yellow: GENERAtOR RETAINS <br />