Laserfiche WebLink
State of California—EnvironmerNA Protection Agency <br />Form Approved OMB No. 20:13-0039 (Expires 9-30.94) See Instructions on back of 1& 6. <br />Please print or type. Form designed forum on elite (12.pirch)Ae. <br />UNIFORM HAZARDOUS I - Generators US EPA ID No. Manifest Document No. <br />WASTE MANIFEST 1C 1A ID 19 18 11 14 16 -1Z 12 1 <br />3. Generator's Name and Mailing Address OHCLL 1 <br />® <br />CiI_to C€7MPANY <br />to <br />HAZARDOUS WASTE DEPT. <br />ij4. <br />P.O. BOX 484 <br />00 <br />Generator's Phone <br />i ) ' —.33 12 e <br />Od <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />00 <br />CROSBY & OVERTON, INC. 9 8 2 5 t- 4 9 0 <br />R <br />Q <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />Q <br />Z <br />9. Designated Facility Name and Site Address <br />g hY IA. US EPA ID Number <br />Sfc <br />O <br />ROMIC ENVIRONMENTAL <br />2081 PAY ROAD CAD 009452657 <br />uEAto <br />c203 <br />Z <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />No. <br />Type <br />i!W <br />� <br />am+ 1 e i_ a <br />i.w1M <br />3 <br />6:[`11993,I <br />G(DO01) <br />E <br />t (Dols) <br />O 1 <br />T T <br />00 <br />N <br />b. <br />00 <br />E <br />v <br />C4 <br />R <br />$A <br />00 <br />T <br />C. <br />.- <br />O <br />x <br />R <br />_L <br />Z <br />d. <br />U <br />j <br />U <br />n <br />j�,. <br />of ns #or Malenols;tsstetf�l4bo , " � a � °� <br />u� <br />-ml:Q <br />Departamst of Toxic Substances Control <br />Socraenento, California <br />2. Paget kd in the shaded areas <br />is not required by Federal law. <br />of <br />13. Total 114. Unit <br />G <br />15. Special Handling Instructions and Additional Information FACILITY: e <br />AVOID CONTACT WITH EYES/SKIN SERVICE STATION <br />24 HOUR EMERGENCY PHONE NUMBER (800,1 /#24-3300 880 VICTN ROAD <br />FLAMMABIE PLACARD REF 11)'51993 PROFILE # 013425 L.ODZg C ref. 95;40 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping nameaced are classified, <br />pocked, marked, and labeled, and are in all respects in proper condition for by highway according to applicable federal, state and international knws. <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 />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future <br />E", <br />to human health and the environment; OR, if 1 am a smcfl ge:ar:tit/ generator, I have made a good faith effort to minimize my waste generation and select the best <br />waste man ement method that is available to me and that I can afford. <br />me Typed Nc e <br />/v"9, it ®_ All, ` ON �idM`,•, I F OF Month Dav Year <br />T 17. Transporter 1 Acknowledgement of Recei Ft of Materials <br />It <br />A Pri /Tye me Sig / Month Day Year <br />i/ 0 <br />P ,, <br />0 18. Tromp2rter 2 Acknowled ement of R ei t of Materials <br />T Printed/Typed Name Signature <br />e Month pay Year <br />a <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <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 <br />v Printed/Typed Name Signature Month Day Year <br />204442508h6+3982 TS <br />DO NOT WRITE BELOW THIS UNE. <br />SC 8022A (12/91) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />4 8700-22 <br />To: P.O. Box 400, Sacramento, CA 95812-0400 <br />