Laserfiche WebLink
state of Coliforn'to—Envirortml I Protection'4aney <br /> form Approved OM8 Na.2-0039(Expires 9-30-99) See Instructions on back of page 6. Department of Toxic Substances Contr, <br /> Please print or tyr: foray esttned for use on elite(12-pitch) ter. Sacramento,California <br /> _+UNICORN HAZARDOUS rotor's US EPAFID No. Manifest Document 2.'tPage I Information in the shaded areas <br /> [7,� <br /> is not required by Federal lawWASTE MANIFEST. la 13 10 10 1' 11 12 4 t of <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number O <br /> S1~RR, L.F. <br /> 1 100 OWne & Couil'I ry R.d. B. State Generator's ID <br /> 770139 <br /> t C`rarl er r, 9 <br /> h 4. Generotor's Phone (71(x714. 150— }�-j y <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporier's ID[Reserved.] <br /> W') <br /> m <br /> D. Transporter's Phone U 87�--414.1 <br /> t1iEF' } l?C`.)`r:� 1f1� rVir '> , }r1. 1 J i ] p ( ) <br /> 7.. Transporter 2 Com an Name ' <br /> p p y B. US EPA ID Number E. State Tronsporter's 1Q[Reserved-] <br /> 3 Q F. Transporter's Phone <br /> V 9. Designated Facility Nome and Site Addregs 10, US EPA ID Number G. State Facility's ID <br /> k•.!-�f 1 r or'tiDenf-a t r <br /> i"C11 10 <br /> W, Firs' Strew <br /> ;, H. facility's Phone r <br /> 0 626)334-5117 <br /> Q . <br /> U <br /> 11. U5 DOT Description(including Proper Shipping Name,Hazard Gass,and ID Number) <br /> 12Containers 13. Total 14. Unit <br /> Na. Type Quantify Wt/Val 1. Waste Number <br /> J Z C'! �r7 i s t e f l aHma t-,; s,,I i ej <br /> 4 1 _LT4J..r2'y. PGI ! i Fq <br /> 3� G PQ./t,Ioiher <br /> E b <br /> N State <br /> CID <br /> co E <br /> 4 R EPA/Other <br /> v A <br /> o T <br /> Stale <br /> 00 O <br /> R EPA/Other <br /> wd. State <br /> Z <br /> w t EPA/Other <br /> U <br /> LU <br /> .1�lr�iti npi, rApflg r tic j f4 gae1 <br /> z t t� � profile# 521186 R. Handling Codes for Wpstes Listed Above <br /> d <br /> rn r <br /> U-1 <br /> C. d. <br /> a <br /> Z <br /> p �tp pli_n al s sRr aIS X1. <br /> ec_ �f� ,+y�^!+Y_.l� �I �Rtwrra�lrff�agatian I s�til.t flk' <br /> Z 24 Hrjur 1 mar&+ncy Responc:_e 0 t 909 i 7'211-20 8 <br /> i tr AddresS:'294. Wavev Dr . <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore fully and accuraiePy 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 /> ti I am a large quantity generator,I certify that I hove a pr ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be econamicolly <br /> CL 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 Fan afford. <br /> 0 <br /> >- Printed/Typed Name Signature Month Day Year <br /> ZU <br /> W 17. Trans rter 1 Acknowled a nt o _ecei i of Materials <br /> JI Printed d Name <br /> Mont Doty Year <br /> W P .� hso // <br /> U- 0 18. rans oder 2 Acknowled ement of Receipt of Materials <br /> O T Printed/Typed Name Signature Month Day Year <br /> w <br /> QIt ^�. <br /> U 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> 1 20. FacilityOwner or Operator Certificafion of t of hazardous materials coveredib This manifest except as noted in Item 19. <br /> T Printed/Ty Afame Signatu'� Month Day Year <br /> Y - <br /> -00,N©7'WRMEyBEC0,1N TFIIS.. :INE. <br /> w ` Yellawc„ TSDF $ENDS 7HlS COPY TO,GENERATOR WITHIN..14.DAYS. <br /> DTSC�f�022A"ff/991 r t (Generororf' b'submlt 1,f ordoue'wgst for tdrpnsspofi-Put-of-state, <br /> EPA B��(i-22 prodJce comp{tfed'cepy a ih s copy an sen to DTS✓` within 30 days.] <br />