Laserfiche WebLink
Form Approved OMB No.2050-0039(E;pna9-30-99) Jon msrrucnunaan uur,wyr F.W. v. uepon emo +.a+anmsmon <br /> Please print or lype. Farm designed forum on Glib 112-pitch)lypewriler. Sacrommm,California <br /> 1. r n ce's US EPA ID No. Manilas)Downw9$�Tarpsurssn'.IDjRsmNumd.I <br /> 2. Page I Information in du shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST C1 �^� 4 of <br /> ��r'.Name and Mailing Add,... ifpt fbeumeat Number. <br /> A LPO 1A'(:tEL �- o s 'It'' 17. <br /> G <br /> ox93 <br /> 17 <br /> P.O,a B. it arar.ID <br /> sy�KrM3. I 9sCQ <br /> ,. valor's Phan. 1 1 9 6�$'J" ' •rnt.�: 70M <br /> N 5. Transporter 1 Company Name 6. U8 EPA ID Number <br /> h <br /> 8 RA9SCS NYIROH ECTAL S C <br /> LID 11614 4 0 C 3 5 5 6 D Transports/s Phone <br /> 916 371-5747 <br /> 7-r 7. Transporter 2 CompanyNam Na8. US EPA ID Number L Stab Transportds 1D IRes rued.I <br />?J F. Traraporier.Phone <br /> vVQ 9. Deaignaud Facility Nome and Site Address 10. US EPA ID Number O. Stora Facility's ID <br />�g RANCHO CORDOVA, LLC-6Ern Fes" <br />)z 1185 WITE ROCK ROAD, •RANCHO CORDOVAN CA 95742 N. FeefiyNPlan. <br /> ro CAD 9 8 0 8 8 4 1 8 3 (916) 351-0980 <br /> Ja H and ID Number) 12. Conbinen 17. Toles) IA. Unit <br /> V 11. U5 DOT Deuripfton(including Proper Shipping Nams, azard Class, �. T Quantity Wt/Vol I. Waste Number <br /> aw As l E �"I MA954 s- `�, A�.d,5-.1 <br /> 3, state 3 <br /> 3 G aAT1993, Pj+�� u,..t s ok) 0 /oR.r <br /> o N b. Slate <br /> co E - EPA/CNher <br /> N R , <br /> v A C. sola <br /> o T <br /> m O - EPA/Odter <br /> R <br /> w d. State <br /> W EPA/Otinr <br /> W <br /> N J. Additional Description,for Materials Listed Above + - K. Handling Cade.for Wastes Listed Above <br /> 2a b. <br /> 11a. <br /> W <br /> m c. _ d. <br /> Z r,Le G <br /> 015. Special Handling Instructions bad Additional Informafion' <br /> HANDLERS TO BE TRAINED AND USE PPE. syc /o"-&) Z4 all A+-� <br /> z 241HR EMERGENCY CONTACT: 916-371-5747 !s�oCkT Jac a.9seF +/V <br /> 16. GENERATOR'S CERTIFICATION: Ihereby declare that the<onteaH of this consignmeataro%Itl nd...0 wlyd.,c,i6.d,6o byproper,hippingnameand.r.cla,,,Iiea,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 1 am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated b the degree 1 have determined to be economically <br /> d predicable and that I have selected the racticabm <br /> le ethod of Immanent,storage,or disposalm <br /> currently mailable m s 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 /> O awliable to me and that 1 can afford. <br /> 114 9 <br /> y Printed/Typed�lem►'• Signature Month Day Year <br /> W 1 17. Trans iter Ackn ed rat of Remi 1 aF Material' /' 444� <br /> K A Printed/Typed Name Signature Month Day Year <br /> W <br /> W ;oc � �? Q r\ O <br /> is. <br /> B 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 RPrinted/Typed NamSignature Monts Day Year <br /> f <br /> H E <br /> a R <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> L <br /> 1 20. Facili Owner or Operator Certification of..i.1 of hazardous materials cmered by this manifest asionst as noted in item 19. <br /> T Printed/Typed Nome Signature M th Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/991 Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700--22 To: P.O. Box A00, Sacramento, CA 95812.OAOO <br />