Laserfiche WebLink
State of California—Environmental Protection Agency v / f / <br /> re Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of page 6. Department of Toxic Substances Control <br /> Please 'nf or type. Form designed for use on elite(12-pile pewrifer. # Sacramento,California <br /> UNIFORM HAZARDOUS 1. enerator's US EPA ID No. Manifest Document No. 2. gd'1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST <br /> :i {; .5 1 F of <br /> 3. Generator's Name and Mailing Address � A. State-Manifest Document Number ss���g <br /> U <br /> ACIFIC-I'S AND PL- TR; SI� r� n DEH u_CPATC�;STAT]C,N L 5 5 3 3 f.: <br /> HQaiB u-tmv—I 24A ui JDlAiE ROAD Irl i~'I LE 11YEST r_R; -i <br /> O Y ''B: SfafA Generator's ID <br /> CA 9 �3?� <br /> 1 <br /> h <br /> A. G neratoril+Phone ). L,�.TI-fR�F si F <br /> n ( if't r— <br /> ) :37^ ' !aW! <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number + C. State Transporters ID Reserved.] <br /> to <br /> a° LOCO iBESTE TPANS= RTAiCIN IiCCPPORAT;Dp <br /> D. Transporter's Phone <br /> 0 1C <br /> N 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID(Reserved.] <br /> NJ <br /> QF. Transporter',Phone <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. tate F cili ' 1.ef 1 �� j ) <br /> � <br /> Lr) 71-`HEMICAL VVASTE'MAl�AGEME.NIT 13NIC' ju t� <br /> LO I O -352511 OLD SKYUNE-'FDOA H. Facility's Phone <br /> (�LL KETTLE—MAN C.1 i`.{'A 91239 r= �1. ITIr, In h k, 1 a h 1 1 1 -7 1 <br /> J� 12. Containers 13. Total l d. Unit v, 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> N z a. ],ION P RA I-AZARCOUS!"STE,S0LJD fSCAL CONT.r MINA.TEDD state <br /> 3 G <br /> VA f H TRJANCE ME --e L3*1 EPA[Other <br /> 6i <br /> w N b. <br /> .x <br /> 00 E EP/t/Qtfjer <br /> .r� R <br /> A } <br /> O T <br /> C. state <br /> co R EAQthe'f' � <br /> LU d <br /> Z <br /> w <br /> U eY " <br /> LU <br /> Z 74ddifional Descr. tons for Materials Listed Above K. Handling Codes:foo.Wastes Listed <br /> O ,* a <br /> f� I T.AMN TEDW{TtiT*ACEM"At,!!`; a•''f71,: C. d. L amt <br /> 15. Special Handlin0structions and Additional Information <br /> Q sty:t$T <br /> PP -alcrves, Pt Wes as ariprw ate24 HR L`critact 4 -Leta Soo - R sn 1 0 f <br /> r ou�: �• t r,1111; s rs rsr. sau, 'rs s c r-t�+w- <br /> w <br /> S <br /> F- <br /> - <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by propershipping name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quontiy 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 economically <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;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 /> Oavailable to me and that I can afford. r <br /> } Printed/Typed Name Si nafu Mont Day Year <br /> z Robert Grafi/ � <br /> w T17. Transporter 1 Acknowledgement of Receipt of Materials <br /> C7 R - <br /> w Printed/Typed Name I Signature Month Day Year <br /> wB 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> O T Printed/Typed Name Signature Month Day Year <br /> LU E <br /> < R <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20, FacilityOwner or Operator Certification of receipt of hazardous materials covered by this-Inanifest except as noted in Item 19. <br /> T Printed/T d Name // Signature �i' Month, Day Yea <br /> Y C� <br /> yo— <br /> DO <br /> G ` <br /> L f <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br /> A1, -1 ( nA . <br />