Laserfiche WebLink
State of Californio—Environmental Protection Agenry .; -7771 <br /> Fofm Approved OMB No.2050-0039(Expires 9.3Q•99) S@@''flStPYCfI ` t <br /> Please print or type. Form designed for use on elite(12•pi <br /> k 94 <br /> `�PJ1A!ttNft of'taxic'Stsbstanees Con1n <br /> `b,'California <br /> UNIFORM HAZARDOUS 1' �' °tvrk US EPA ID No. 4slattiftpt N6* .: fPagtt 1 lnfornlotli shaded areas <br /> WASTE MANIFEST C ,"'.` <br /> !� is not rpgyfred by'Eederol lave. <br /> m, 3. Generator's Nome and Mailing Address <br /> fJ%TA PLArP.W,, INC . <br /> p a5"rANI SMF" <br /> W) A. Generator's Phone CA 95206 (209)948-2768 <br /> 'N 5. Transporter I:Compony Nome 6. US EPA ID Number <br /> $ 21St. tERITIRY 13iI11 C1 Al RI 010101 11 6141,0111 <br /> 7. Transporter 2 Company Name 8. US EPA ID Qlumber <br /> coV 9. Designated Facility Nome and Site Address 10. US EPA ID Number <br /> Mg 21.3 t Century Ml <br /> Z <br /> ac 2095 Nkwlarms Ur. mat <br /> NJ V! F)l 8101151 91 51 31 <br /> NU 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12.Couto nen >3:Tela) 14. Unit> <br /> Z a. No. T GtuaMi ;: Wt/Vol <br /> X HABAM$ VASYS, SOLID, S.O.S. 0116} 9 U3177 PGIN IQ(11) <br /> 3 c lr9C(171! -R <br /> o N P <br /> b. "� <br /> CID E K�' DALAYI'WS MASTS, 80L10. H.O.S. (CHVOlIU) 9 KA3177 FG1II <br /> 4t R A k)(061171, BPC(P'ti' BI AjgrApj <br /> o <br /> R. 3o-r7 F?C-�BIZ K 4 <br /> LIJ <br /> d. <br /> W <br /> Z J. Additional Descriptions for Materials listed Above <br /> p :} I941E03-A6 - tildt FILMa" 5T-wiLAj <br /> tict#- <br /> vas IrT20 d1} <br /> a <br /> 0 15. Special Handling Instructions and Additional Information <br /> Z VC)l PROPER F10?6CT1VK CLOTt IM. OL 6MY I 'cPoxss F I '$81} 567-7154. <br /> LU <br /> Q16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and oecuraw described above by proper ship ping nam®and aro tkusifisd,packed, <br /> V <br /> marked,and labeled,and are in oil respects in proper condition For transport by highway according to app icabie internationaI and national govrlrnment regulations. ' <br /> If I am o large quantity generator,I certify that I have a program in place to reduce the velum®and toxics of <br /> h practicable and that I have selected the racticable method of treatment,storage,or die la wasteomgenerated ro the degree I have determined ro be economic 11 <br /> crag poral,currently oyodobb to me whi�is shin Ilk lead future threat to.human health <br /> and the environment;at I if I am a sm (quantity generator,I have made a good faith effort to minimize;my waste'gemerQtigrt tt: 1, f ffie I wash mandgement method filet is <br /> available to me and that 1 can afford. <br /> V Printed/Typed Nome Sign re ' <br /> IfAont� Day <br /> .n Year <br /> :? A'' fj <br /> Z . <br /> W T 17. Trans orter 1 Acknowled ement of Recei t of Moferials <br /> C7 R <br /> w A Printed/Typed Nome l Signature <br /> w S ' ��� li- .t '• '� , �n Month Day Year <br /> O0 18. Transporter 2 Acknowled ement of Receipt of Materials v�� <br /> T Printed/Typed Name <br /> W E Signature <br /> R Month.t ' Dcy. Year, <br /> N <br /> V19. Discrepancy Indication Space <br /> Z F <br /> A ¢; ; <br /> L <br /> `' <br /> 20. Facili Owner or O rotor Certification of recei t of hazardous materials c ered b;this manifest except as Ito lfk"i <br /> T Printed/Typed Name Snature/ <br /> Y(. 1 %�� ,S y Month Day <br /> � // Year.. <br /> DO NOT WRITE BELOW THIS LINE. <br /> 1'e�ow: TSDF-SENDS THIS COPY TO GENERATOR WITHIN 30�'DAYS,.` <br /> DTSC 8022A(1/99) (Generators who submithazardous waste for transport,cul of stale, <br /> EPA 8700-22 produce completed copy of this copy`and send to DTSC'within 30 days.) ' <br /> 12-07-05P02 : 15 RCV-D <br />