Laserfiche WebLink
StateofCalirorma—cmronm.nm .vec o ..ym••r bee InsTruCTIi on ou,wyr P-titos.• =w•• <br /> Farm Approved OMB No.2050-0039(Expires 9-30*99) Sacramento,California <br /> Please prim or,ype. Form designed for use on elite(12 pikh)typewriter. <br /> 1. G 's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS / is not required by Federal I.- <br /> WA E <br /> aw.WASTE MANIFEST 9 11 2 Pe a S of <br /> A Stale Manifest Document Number 24,317302 <br /> J. Gsnaroror9 Name and Mailing Address <br /> F/IEPCO LABEL SYSTEIMS e . <br /> o P.O.BOX 932r 23TOC.KTON. CX 95=1 B. Show Gene atoi s ID <br /> h <br /> A. Generator's Phone •��teR fkte-i3?.Ai r`III T: TOM Of\:J3tM <br /> h ( �"�- <br /> 6. US EPA ID Number C. Srote Tronsparte/s ID Roserwd.l <br /> N S. Transporter 1 Company Name - <br /> m Ramoi ErtaiF-t�r`sEseRi4ai Serviars Q 3 <br /> 56 D. Tran.parters Phan. 996 371-5741 <br /> 0 <br /> 10 E. Stat*Transprtee,ID Reserved.] <br /> m 7. Transporter 2 Company Name 8. US EPA ID Number <br /> I F. Tsanspnrler's Mone <br /> 1� <br /> .UG. State Faciliys ID <br /> Desi ruled F«ili Name and Site Address 10. US EPA ID Number <br /> a �danc�t3o Col ova LLC <br /> tI=White Ruck Rd. N Facilitys Phan. _ 916 351-0980 <br /> •O Rancho Cordova, CA 957A2. $ ,1 `; <br /> LL <br /> 12. Contoinars 13. Total 11. Unit <br /> Q 11. US DOT Description fincludirg Proper Shipping Name,Hazard Class,and ID Number) No T Quantity Wt/vol I. Waste Number <br /> U slat* 3:: <br /> Z ,Jk�o. ,s� C y� UN. <br /> q� n r� 1 <br /> r V as-Ae 7 lC3�rii-S{ble t itid , N.0.L., 3, UI?1993, G�II ,/� EPA/OtMr <br /> 3 G 1 —( !11T119' F``Z P. f' �I can Dmf <br /> E <br /> mN EPA/tORs« <br /> m E <br /> A Stara <br /> T <br /> m O EPA/Other <br /> R slap <br /> w d. <br /> Z EPA/Other <br /> W <br /> V <br /> W _ K. Handling Codes for Wastes fisted Above <br /> J. Additional Descriptions far Materiah Listed Above - <br /> Z a. b. <br /> ° s X T!5- I <br /> W C ..fes d. <br /> .Q <br /> Q <br /> I5. Special Handling Instructions and Additional Information <br /> g ) MILLERS TO BE TR✓\I NEC'. xC f� S f 7 <br /> i• 21 HR. EMERGENCY CONTA.kTr: 813-371=5747 Job# Pr3fic� <br /> As 29 ALPR0FxA ST., STOX-la'7N. CA., 05202 J <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declaro that the contents of this comignment are fully and accurately described oboes by proper shipyIng name and are classified,pa <br /> cksd, <br /> Vmarked,and labeled,and ars in all respects in proper condition for transport by highway according ro applicable international and national government regulations. <br /> If 1 am a large quantity generator, nrfily that I have v pr ram in place to reduce the volume and toxicity of wash generated to the degree I hme delerminsed ro b.«anomicallY <br /> N practicobls and that have selected the practicable method of treatment,storage,or dispwal cummlly available ro me which minimizes the present and future threat ro human health <br /> and the environment;OR,if I am a small quontiy generator, have made a good faith st to minimize my wash generation and eel«t the best waste management method that n <br /> CA avoilable to me and that I can afford. <br /> �y9 signaNro �}Mondt <br /> Day Year <br /> aTypsicl <br /> z 11so <br /> W L 17. Trans Mr 1 Acknowled smart of Receipt of Materials <br /> R Printed/Typed Name SignaNrsr- �rMondt Day Year <br /> w <br /> Is CGH�tC._ �E� <br /> P <br /> LL R 18. Trans rir 2 Acknowled emeN of Receiot of Materials pay Year <br /> O R Printed/Typed Nome Signaturs /•tOn* <br /> I <br /> vo 'R <br /> LL) 19. Discrepancy Indication SPace <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or 02annto,Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. Monde Day Year <br /> T Printed/Typed Name SignaNrs <br /> Y M <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS, <br /> DTSC 8022A 11/991 To: P.O. Boz 100, Sacramento, CA 95812-0100 <br /> EPA 8700-22 <br />