Laserfiche WebLink
State of Colifornia—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30.0" ' See,IflstfgCtfotts on bacis page 6. Department of Toxic Substances ControlPlease print or type. Form designed for use on elite _typewriter. - e k? 51. 1 Sacramento,California <br /> UNIFORM HAZARDOUS b; Generatorts US EPA ID No. v Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST ' I is not required by Federal low, <br /> I f I t" z E ' ? 2 4 1 of 1 <br /> qqt 3. Generator's Nome and Mailing Address A. State Manifest Document Number <br /> d 1 L 014, <br /> pc ^ <br /> , <br /> tt _ `�1' 1 Irsf o B. State Oenera4or s 1D t <br /> I 4. Generator's Phone Y <br /> ry <br /> W5. Transporter 1 Company Name 6. US EPA ID Number C. state Transporter s ft1 ht <br /> i D. Tto sportees Rhona <br /> Ot775 1, <br /> ro t Cf`�LJ4eX ..�Ia f t <br /> iAllm�,$ 7. Transporter 2 Company Name 8. US EPA ID Number E. State TranaporterslD,le„ry '^m?', «, <br /> V 11 J z <br /> J <br /> Q F.;Tronsporter's Phone a <br /> �T <br /> U 9 Designated Facility Name and Site Address 10. US EPA ID Number G. State Fod i s ID - <br /> CID <br /> z tiLtti: 4i ! 1CX <br /> 715,13 . <br /> 0';', t e I u ic! C7I , x35 1, H. Facility's,Phome` <br /> 0 <br /> Q 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Num6er) 12• Contoiners 13. Toto 4.-Unit , =`�: a _ <br /> U <br /> a. No. Type Quantity Wt/Vol I.Waste Number ' <br /> Z <br /> nY1A4 iUE SO!'.�".0 uV;.9 $ .GII R (0666) 7RGli5fl <br /> � E O ,�` �r 4 0 G DOOZ <br /> 6PA�Qther <br /> o N 6. 1 <br /> co E esu.r ruw-it ;d.Jl t17"yiX3.-7r. <br /> v R ^0 EPA/Other <br /> OMAN <br /> o T ` <br /> State <br /> 00 O <br /> R EP <br /> Z d Stare< <br /> v <br /> Lu "t °r <br /> V) J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wa res:Listed Above { <br /> 0 li 3AIb11_16 SODIUM HTUR,OXID6 SOLUTION - MAS12-3 {I� °' �� <br /> V) <br /> ac <br /> Q c. d <br /> Z 15. Special Handling Instructions and Additional Information / <br /> - <br /> Q rcn ,sa:,,,, t ,,;.;'ilii)' orti;;Ett„1 sr.SFtla5a. ftutik6U; j67 74�a. <br /> Z <br /> Lu <br /> —J+ 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Q I marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and not <br /> government regulations. <br /> V <br /> tcLlLPrintad <br /> large quantity generator,t certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economical)y <br /> e and that I have selected the rracticoble method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human healZ <br /> onvironment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> O to me and that I can afford. <br /> >_ ome Sig atu s ? onth Do Y. Transporter 1 Acknowledgement of Recei t of Materials <br /> Lu A Printed/Typed Name Signature <br /> N Month Day Year <br /> r � dy <br /> w P s d uI. p cr t..-, .r l` x_ ✓ v-z <t lJ �! ! O <br /> LL_ 0 18. Transporter 2 Acknowledgement of Recei t of Materials <br /> o R Printed/Typed Name Signature <br /> Lu E Month Day Year <br /> v) R <br /> Q <br /> U F 19. Discrepancy Indication Space <br /> Z A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered-by this manifest except as noted in Item 19. <br /> T Printed/Typed Name SignaWre <br /> T. th Day Yeor <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) <br /> EPA 8700-22 <br />