Laserfiche WebLink
Store of Colifomia—Emironmanlal Protection Agency ...r <br /> Form Approved OMB No.2050-0039(Expirm 9-30-94) See InftrUtlipnf On back dT'bGge b. oeportment of Toxic Substances Comrc <br /> Smanallo.California <br /> %ease print or type. Form designed for use an eFh(12pikh)Mcown", <br /> 1. Crerorabr's US EPA ID No. Maddest Docureerrt No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS 9 7 0 24 of 1 is Trot required by Federal law. <br /> WASTE MANIFEST316 19 19 Lg <br /> 3. Cserreralor's Name�d Mailing Address Do t mart!lumber <br /> �v'E�i 0n rF u4vd opt,$ A.2Y �oc!('1u+ "� <br /> i - 93697024 <br /> h �/O S•Ai✓ro✓t a04 y $'toek'&NCa. 9S,.2 o6 11. Sitoo,GPMrmo.x ID .. <br /> n <br /> C4 a. Gmwraor's Phone (z,y)97-2 -YY/6 106 <br /> 00 5. Transporter 1 Company Name 6. US EPA ID Number C Soh Tra sponer's ID. <br /> m ASBURY ENVIRONMENTAL SERVICES 77 D,.lm po er'sPnane (310)886-3400 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID - <br /> UTronsporielx Phone <br /> d' Z 9. Designated Facility Nome and Site Address 10. US EPA ID Number `Soh Facy's ID <br /> 1 <br /> p DEMENNO/KERDOONProne <br /> ( )310 537-7100 f <br /> a 2000 N. ALANEDA ST, CONPTON, CA 90222 <br /> T <br /> U 12. Containers 13, Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No T ype Quantity Wt/Vol 1. Waste Number <br /> 113 State 135 <br /> CIO = "Ethylene glycol non-RCRA <br /> Q� 3 G Hazardous waste liquid No Placard Required 1 TT 0101v ` G EPA/cher <br /> c�i E State <br /> m N Is. <br /> E EPA/Other <br /> � sQ <br /> h T Stare , <br /> b <. <br /> O0 O <br /> \ EPA/ONner <br /> � R <br /> We <br /> Z d' <br /> w <br /> (� EPAlOther <br /> W <br /> N <br /> Z 11E AddNond Lbsrsiptiom for Materials listed Above tq Codes for Wastes Listed Above <br /> 2 ETHYLI.NE GLYCOL 20%-40% b. <br /> WATER 79%-55% <br /> T,OR OIL 01%-05% <br /> O 13. Special Man.dling Instructions and Additional Information EMERGENCY RESPONSE CONTACT: <br /> a GLOVES' & GOGGLES 24 HOURS <br /> Z <br /> W <br /> H <br /> � 16. f3fRifERATOR'5 CERTIFICATION: I hereby dnclarc that the contenA of this consignment aro fully and accurately described above by proper shipping name and are classified, <br /> a <br /> pocked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national gowmment regulations. <br /> u <br /> If I am a large quantity generator, I certify that I hove a program in place N reduce the volume and taxicity of want generated to the degree I have determined to be <br /> zi 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 /> d threats to human bmhh and the"Arommeni OR, N 1 am a small quantity generator, I have made a good faith effort to minimize my wash generation and select the best <br /> waste mono emeP <br /> 1 method that is awilable to me and that I can afford <br /> QPrimed/Typed Nanta ,1v V V\\\l� S'g hes, <br /> Za 17. Tircumparher 1 Ackm+wled mem of Recei t of Materials <br /> ' IWx ♦ PNnbd Typed meSi9riaNr D �}-y Day Year <br /> y N YI <br /> aC 5 1 (1 ✓ GN <br /> W P <br /> 0 18. Transporter 2 Acknowfed ement of Receipt 0!Materials <br /> W r Primed/Typed Name Signature MciA Day Year <br /> LL E <br /> O e <br /> W 19. Discrepancy lndication Space <br /> N <br /> A ENVIRONMENTAL HEALTH <br /> Z C PERMITISERVICES <br /> L 'edification of receipt of hazardous materials coveted b this manifest exceptas noted in hem 19. <br /> s 20. F«il' Owner or Operator C <br /> T Printed/Typed Nome Signature Me Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS UNE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DISC 8012A (9/97) <br /> To: P.O. Be. 400, Sacromento, CA 958120400 <br /> EPA g7g " <br />