Laserfiche WebLink
State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back of page <br />Please print or type. form designed for use on elite 112 -pitch) typewriter <br />Department of Toxic Substnor.w C—t—I <br />DO NOT WRITE BELOW THIS LINE. <br />C 8022A (1/99) <br />8700-22 Yellow: GENERATOR RETAINS <br />C <br />Sacramento, California <br />UNIFORM HAZARDOUS�'Gneracr's US EPA ID No. Manifest Document No.t-2.P.ge l. Information in the shaded areas <br />WASTE MANIFEST is not required by Federal law. <br />x 2 01 5 of <br />3. Generator's Name and Mailing Address <br />A. State Manifest Document Number <br />am JMQf7T,f couffTx 2441110-05 <br />D�.1810 <br />9 MZLETON <br />n <br />B. State Generator's ID <br />4.RPN '?Ilton 952PI iM1+'1TN;-LIISON H V D 9 0 N <br />14 <br />S. Transporter 1 Company Name b. US EPA ID Number <br />C. State Transporter's ID [Reserved.] <br />O <br />O <br />D. Transporter's Phone - <br />_ <br />7. Transporter Company Name <br />P P Y 8. US EPA ID Number <br />a 1 <br />E. State Transporter's ID [Reserved.] <br />J <br />( <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />%Yataah cavirclnnwnt'al Oo rporatian <br />i <br />1420 South CteNmat fit#.. <br />H. Facility's Phone <br />� <br />Prtttdranii� � t567�t5 <br />r <br />1 2 oain <br />US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />rs 3 a 14. Unit1. <br />No. <br />Type Quantity Wt/Vol I. Waste Number <br />a PAINT 1XIA4".M 69iTZRIAL, 9, ON1263, PY 11, <br />State <br />1l-Y16i'4) , 1�if : eA1M2s�ll i <br />407,55-e, Q <br />- E <br />ry <br />75+ <br />EPA/Other <br />j N <br />b. t►1dfKUL& IZQNIDB, N.O.S., 3, VN1993, Pa II, <br />MAC <br />State <br />i E <br />(Gaualtm , ALcohol), (pt: M42115) <br />612, <br />1 R <br />EPA/Other <br />r <br />/Et <br />t T <br />c <br />State <br />i O <br />R <br />EPA/Other <br />i <br />d, <br />— <br />State <br />I <br />I <br />EPA/Other <br />� <br />J. Additional Descriptions for Materials Listed Above <br />* Ilk: C0 41911(+� <br />k A 3 } k+� 11.18: C�L4211! ( '7 4 575 j = <br />K. Handling Codes for Wastes Listed Above <br />a. b <br />7- <br />C, <br />d. <br />15. Special Handling Instructions and Additional Information <br />/after if NiNA sXmupt pbr NO CV5k 251.4 (%) (1) 6=1tseiorl. teams praprsr 9PlS whan harAling hm2g,rdous <br />sat*tlals, Sltb25249 8. TxsOY lllVd, Tsacy M 95876/ Job # 1403-06100 / CRG Quid* 127 , 126 <br />smaxlerArl CmtaatI irra?RFic (800)696-"53 RW", PROPCTK PB.U"XVZ 11Mn=j (►!)<)iWry ZAjLDLIRW <br />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 />marked, 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 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 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 />available to me and that I can afford. <br />Printed/Typed Name 01 �wts^ CI, <br />Signatu <br />Month Day Year <br />t,[to <br />T <br />R <br />17. Trans orter 1 Acknow ed ant of Receipt of Materials + <br />A <br />N <br />Printed/Typed Name <br />Signature /'� <br />Month 'Day Year <br />p <br />G. L r <br />0 <br />8 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />Printed/Typed ed Name <br />YP <br />Signature <br />g <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. facility Owner or Operator Certification of receipt of hazardous materials covered by 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 THIS LINE. <br />C 8022A (1/99) <br />8700-22 Yellow: GENERATOR RETAINS <br />C <br />