Laserfiche WebLink
'State of C_ olifomio—EnvirJnmel Protection Agency <br />Form A d OMB.[Jo. 2050-0039 (Expires 9.30-94) S@@ Instructions Oft b®C�C g@ 6• Department ra Toxic California Control <br />Tl��WASTE <br />dForrn designed for use on elite (12 -pitch) typewriter.Sacramento, C°lifornia1. Generators US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br />IFORM HAZARDOUS is not required by Federal law. <br />MANIFEST C L U U U () U � r U L ''I D 17 f °f <br />® 3. Generator's Name and Mailing Address <br />PAC IF COAPT PRoDuce.RS <br />1(4) So. SrUCK-10nt Sr <br />"t <br />C4 4. Generator's Phone (2 d) 334, 3352 LU 1) 1, C' n <br />5. Transporter) Company Name <br />6. US EPA ID Number <br />coco <br />EVERGREEN VI RT SERV. Cl <br />! U <br />CD <br />d_ <br />Z <br />0 <br />a <br />Z <br />3 G <br />E <br />0o N <br />°o E <br />N R <br />A <br />0 T <br />O <br />R <br />w <br />Z <br />w <br />U <br />Mill <br />7. Transporter 2 Company Name 8. U&fpA:}D �umtser x.-.•` All. U.S.P.C.I. TI XI 1 1 181 1 SI <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />U.S. .C.I. T.R.S. <br />1021 Kerr s <br />72. Containers <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) No. ° Type <br />NON <br />RcRA HA7ARDOUS WASTE SOLID& ®®i p <br />IN <br />b. <br />C. <br />d. <br />13. Total ' I:. M Unit <br />Quantity Wt/Vol <br />w, <br />Or <br />:. <br />Q <br />Z <br />0 <br />15. Special Handling Instructions and Additional Information <br />a <br />r. P ctive Clothing 24 Hour ncy Con Ct - Kirk Hayward <br />Z <br />Ti k X131 rgency Telephone - 1-510495-4400 <br />-a <br />- <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 />in condition for transport by highway according to applicable federal, state and international laws. <br />Q <br />packed, marked, and labeled, and are in all respects proper <br />U� <br />If .I am a large quantity generator, I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br />of treatmelll storage, or disposal currently available to me which minimizes the present and future <br />-u <br />li <br />economically practicable and that I have selected the practicable method <br />threat to human health and the environment; -OR, if I am a small quantity generator,;) have made a good faith effort to minimize my waste generation and select the best <br />to <br />waste management method that is available to me and that I can afford. _ Month Day Year <br />o <br />Printed/Typed N/ Signature / f <br />U <br />Z <br />T <br />17. ran orter 1 Ac now d ell -of-Materials <br />e Month Year <br />O <br />a <br />N <br />Signature' <br />Printed Typed Name t ® Cj /1q 13 <br />l 6i <br />W <br />s <br />t!) i�(�1SGPi i <br />P <br />18. Transporter 2 Acknowledgement of Rel of Materials t « Month Day Year.. <br />1L <br />T <br />Printed/Typed Name Signature <br />0 <br />R <br />LU <br />19. Discrepancy Indication Space <br />N <br />Q <br />F <br />U <br />A <br />Z <br />C <br />1 <br />120. <br />Facili Owner or O rator Certification of receipt of hazardous materials <br />covered b this manifes4 exce t as noted in Item 19. Month Day Year <br />Y <br />Printed/Typed Name <br />Signature <br />I I I 1 <br />DTSC 8022A (7/92) <br />EPA 8700-22 <br />Yellow: GENERATOR RETAINS <br />