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407 <br />'font Comia-Environmental Protection Agenry„„_�,,.(�, <br />Cw lwwew wa:w I.w..l. w w8 !G <br />011,6 110. ��. <br />Form designed for use on &/He (12 -pitch) *ewriter.' Sacramento, California <br />9. Designated Facility Name and Site Address 10. US EPA I D Num <br />e <br />�•11. <br />505 <br />13968 <br />V=1 ITAKINT-W <br />W S <br />�,UNIFORM HAZARDOUS', - <br />ty <br />P <br />o <br />- IS. TrofrisoGitir '2Acknoaeclsiment of Recei t of Materials ' <br />'WASTE MANIFEST <br />Printed/Typed Nome ' <br />Signature <br />US DOT tion er rd Class and ID <br />L4. t: <br />®e <br />3. Generator's Name and Moiling Address C—ERS <br />PACIFIC COAST PRODU <br />•. 35 5 STOCKTON 'ST <br />19. Discrepancy Indication Space <br />N <br />;.. X;.6. <br />�.as <br />WASTE airLE' LIQVI <br />4991erator's Phone —3352 <br />(209)334 <br />1 <br />5. Transporter I Company Name US EPA D Number <br />T1h, a \�\ <br />� <br />y <br />CORP. I <br />Printed/Typed Name <br />Signature ; <br />7. Transporter 2 Company Name S. US EPA ID Number <br />Y <br />1 <br />/Ifilil” <br />g <br />J <br />Q <br />^Z� T5. Special Handling Instructions and Additional Information -9313:, 2 " —vl — <br />Z' <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 />� , .po applicable federal, state and, international laws. <br />Q packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to pp' <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 degree I have determined to be <br />'r economically practicable and that 1 have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future <br />y threat to human health and the environment; OR, if 1 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 mane ement method that is available to and that l can afford. <br />Printed/Typed Name Si nature Month Day Year <br />Ix I VX <br />r 7, <br />Z T <br />9. Designated Facility Name and Site Address 10. US EPA I D Num <br />e <br />Printed/Typed Name <br />505 <br />13968 <br />Month Da Year.._. <br />Y <br />W S <br />SA LIDACA 95368 CA <br />w <br />�. <br />P <br />o <br />- IS. TrofrisoGitir '2Acknoaeclsiment of Recei t of Materials ' <br />'� T' <br />Printed/Typed Nome ' <br />Signature <br />US DOT tion er rd Class and ID <br />L4. t: <br />®e <br />t• • <br />r <br />19. Discrepancy Indication Space <br />N <br />h\§ \Z <br />K <br />�.as <br />WASTE airLE' LIQVI <br />1 <br />I20. <br />T1h, a \�\ <br />covered b this manifest except as noted in Item 19. <br />* 01) <br />Printed/Typed Name <br />Signature ; <br />Month Day Year <br />Y <br />1 <br />/Ifilil” <br />\l^�\,:"g <br />g <br />J <br />Q <br />^Z� T5. Special Handling Instructions and Additional Information -9313:, 2 " —vl — <br />Z' <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 />� , .po applicable federal, state and, international laws. <br />Q packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to pp' <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 degree I have determined to be <br />'r economically practicable and that 1 have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future <br />y threat to human health and the environment; OR, if 1 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 mane ement method that is available to and that l can afford. <br />Printed/Typed Name Si nature Month Day Year <br />Ix I VX <br />r 7, <br />Z T <br />aterials x <br />eent of Receipt of Materials- <br />Trans orter Acknow a m <br />It <br />It <br />1D A <br />Printed/Typed Name <br />Signature <br />- <br />Month Da Year.._. <br />Y <br />W S <br />.../ <br />w <br />�. <br />P <br />o <br />- IS. TrofrisoGitir '2Acknoaeclsiment of Recei t of Materials ' <br />'� T' <br />Printed/Typed Nome ' <br />Signature <br />Month Day Year <br />L4. t: <br />®e <br />W <br />19. Discrepancy Indication Space <br />N <br />U A <br />Z C <br />1 <br />I20. <br />Facili Owner or rotor Certification of recei t of hazardous materials <br />covered b this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature ; <br />Month Day Year <br />Y <br />DO NOT . WRITE BELOW IM15 LINt.- <br />DTSC 8022A (7/92) <br />EPA 8700-22 Yellow: GENERATOR RETAINS <br />