Laserfiche WebLink
01/26/2010 12:43 FAX ���� <br />sbb of Colilcrnlo—Enviromnenial Proreclan Agency '�4 0(` <br />Fans Appro- OMB No. 2050-0039 (Expires 9.30.991© <br />Pleas prim K YPe. Farm d,Pan.d for w. an .lib f; 2 -Pi -hl ypewdbr. <br />7 , Oeneromr's US !I <br />UNIFORM HAZARDOUS <br />e WASTE MANIFEST I Q <br />r 3. Genarelerh Nome and Mailing Addnu ry. n <br />f�003/019 <br />back of P•b. D.ponm.m of To ie Subaancm Connal <br />a<mmenlo, Califarnle <br />U;9,23799917 <br />a,wion in lherhaded areas <br />r Nqulnd by Federal law. <br />r ^�,.e A I <br />��y�.4/•r- / �[]�3�Q <br />Lag +�i✓es <br />1, stats6.ner.ror'lID .. - .. . <br />o <br />1 r F' <br />A. Generaror9 than. 129 <br />f\ <br />b. U$ EPA ID ambo <br />C. Sob TmmpaRer'e ID (RnsecsdJ <br />w <br />C A D 9 6 2 4 1 3 2 6 2 <br />D. Tnn.eendn PFe e <br />gm <br />7 T C!. u5 EPA ID Number <br />CA063547998 <br />E. 51ole.hansporbr's ID I eemed.P <br />IA ION, INC. <br />F. Transpar.c's ehgne <br />ID: US EVA ID Number <br />G. Slab Foc'iry4ID <br />Qi s <br />mp <br />�1E�end$yynddr..e <br />2085 Y, tw 894�08� N' V D 9 B 0 8 9 5 3 3"8 <br />FHRtIHL <br />N. to iyt <br />wanes <br />276D <br />. <br />,, 12. CenPoin.n <br />11, US DOT D.aeriplian (lnelodin, Peeper Shippiry N me, Fymed CIPS , 6nd ID Namberl No, <br />T pe <br />13, Tool <br />Guanllry <br />14. Unil <br />WI/vol <br />I. Waele Num6.r <br />U <br />EPA <br />3,vi�i43�i/l <br />3 <br />e <br />AL <br />00 <br />E <br />N <br />\ Z <br />5'°" <br />eA <br />uni! yS h <br />Q <br />rE <br />r <br />E <br />ri'i oo I <br />e <br />A <br />e. <br />Slaro <br />p� <br />S <br />0 <br />EPA/olh.r <br />R <br />Sale <br />I Z <br />E A/Olhm <br />U <br />wQK, <br />Handling Coda 16rWheh. LiMd A6.Jdditjo aln Oa �,I017arfiiat <br />b. /y <br />�1 <br />nb o <br />W <br />1C . i.• d <br />a <br />lld <br />a <br />Z <br />0 <br />15, Special Handling Inslruclian. and Addilional lnlernlallon <br />llb_ <br />24 HOUR. MMMCT CODTTACT_EVHRMM OIL / 51.0-608-0128 13 lK ,... <br />i <br />WEAR PROTECTIVE CLDMING k MWEAR SITS= S7RG 1 . <br />16. oFNEIATOg'S ClRTIFlDATION: Iho.6yd.dare lhonha corr., slaf lhivand8nm nt on sally and oc-rarely dascdbed eba•e b�proper chipping name end an dmsiflad, pedad, <br />highwrry le oppliwbla inlernaliona and ,wlianal garamm.nl regaldl'ens <br />6 <br />marked, and 1a6.i.d, and or. in all asp.ctr in prbpjn..diIib lar trampan h' according <br />V <br />If I am a ler,. gwnKly pr..Wr, 1 e. 11hy trot I Men o proopp'' min place ea reduce the vul m. and taeicih, I wawa ganeraled M he doges, I have del.rmlead b 6e eeenamlcallT' <br />yenlmenq siamg., er dispmal aorrently ovollable N me which minimle., d,. proems and lulwe Iheeal tP human health <br />hal Is <br />• S <br />N <br />pma,.1cle and Ihal I Naas .elected IM pmdic.61e medrod . <br />and rho emiranm.N; OR, 01 am a smolt gwnlit, g.n.lwal, I hon mods a 9.ad fuilh eRarl w minimise my w IN generation and ashes rhe 601 wmre manog.menl mphod <br />Oa�aileb6 <br />to me and lhas I can afford. der <br />sl . Mpnlh_ r0 <br />r <br />V.Li. <br />Pri dNe a moi) Nl%f/wr Io.W / G <br />�}I 'I�/"/�f�/f <br />`6c <br />A <br />F of Merlalr <br />17. T,.ns eels C6-wl/ed dm.nl of R.e.i b <br />5',Ofore L. <br />I <br />Prinnd/T,,. a <br />> <br />W <br />T <br />r <br />n <br />I8. Tr rN, 2 Aeewl.d more 1 R.mi l of Mm.rmle Month Day year <br />O <br />�' <br />ne a <br />Pm.N T ped Nam. <br />W. <br />-wQ <br />•' L} <br />E <br />! <br />19. Dieinponrylntlicelien Space <br />z <br />— <br />A <br />A <br />C <br />I <br />!2 <br />FPcili Owner ar O e+amr C.rti iealio ei l of hozardw. MON ia6 eo-rored b a ileal axce a haled in IN <br />hanFF Day Year <br />I <br />T <br />signarur _ <br />Prins Typed Nam. <br />T <br />DO NOT WRITE BELOW THIS LINE. <br />Whhe: TSDF SENDS THIS COPY TO DTSC WITHIN 70 DAYS, <br />DTSC <br />8022A (1/99) Ta: P.O. 8m 3000, Sewmenla, CA 95012 <br />EPA 87022 <br />- <br />