Laserfiche WebLink
State of allfornia-411sulth d Welfare Agency r r *'' � ,r of Service. <br /> Form Apved OIWB N3 2"0-4)M9{Expke3 9 v, , �, h �aawewCaa�+pl QNhio <br /> r T <br /> c <br /> . Pleaswim-041-9.vemond <br /> se print or type. (ForrA deaiglled for o11 GYI ifplhf�t tyyOfwtter,� " ,+ +Z 7Yi Y �Y ''s ++� r � <br /> 77 <br /> UNIFORM HAZARDOUS }• Generators 08 EPA M..Np .4;,�ti, � � '4 IMNAQO arelr"y� <br /> WASTE MANIFEST ' �i . , i list rrgk+dt"gr:i?iairal t.+r` , � `s <br /> 3. Gonersttoes Name and Mailing Address <br /> QROVW <br /> �Y�VH aViLe j CA •���� '�. � ����#s14." P � � 4 <br /> t +� d <br /> C Generatoes Phone 4109 ) [94-7307 � '�r•� <br /> + 6. Tranaportw 1 Company Name d. US EPA 10 Numberaz ,a.'' <br /> E <br /> NATIONAL MROXMWAL COD. CAD 9 8 14 3 8 1 +1 b <br /> 04 <br /> 10 7. Transporter 2 Company Name a. US EPA ID Number F <br /> °pp€° rf1 <br /> �d77 <br /> Q. Designated Facility Name and Site Address 10. US EPA ID Number .$.• tai <br /> � ,tUq}ZBSUN SOLID RAST'R, INC, <br /> v 18703 CAMBRIDG2 RD. gt <br /> A)MERSON, CA 96007 CAA 4 8 1 3 8 a 9 S 2 <br /> �V 12. Containers 13. Total14. <br /> t-/ LLQ It. US DOT Description(Including Proper Shipping Name.Hazard Claes,and ID Number) Ouentity Unit a Wasto No <br /> No. I Type WiIVol <br /> J <br /> 4�0� a. "R.Q." WASTE HAZARDOUS, l3M7ABCE SOLID, x f� state 151 <br /> .V — C EPA10ther <br /> cks- <br /> N a-o-e. ORK-B Xk9188 (ASBESTOS) RIA ? - <br /> E b. Stella k'. <br /> ' (�i R EMERGENCY CONTACTI: 1-800-535-5093 <br /> T EPj1lOMar z°`e <br /> vO I I I I I I i >: r�11•. .� <br /> as AlOtfter ,e;: <br /> lLLL I d, StetO'a <br /> J- <br /> W EPAMther f <br /> U <br /> ZJ. Additional Descriptions for Materials Listed Above 4L FIanQILty Codas for Wastes Ltsled Above I <br /> LL - - ,_ti Fn'iI ti *'6 sr, • t`6 ._ ! <br /> W <br /> I <br /> F 15. Special Handling Instructions and Additional Information <br /> Z DSD NOT gin BAGS OR CAUSE DUST, AVOID U ATHTNG DUST. <br /> BURT SEPSAATELT AND COVER WITH BACKnLLe <br /> >D MKRCT RESPONSE PADS If 1-800-535-5033. <br /> J <br /> 4 16. <br /> U <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents pf this consignment ars fully and accurately described above by proper shipping name <br /> J and are classified,packed,marked,and labeled,and are in all respectsin proper condition for transport by highway according to applicable international and <br /> fi nations$government regulations. <br /> W <br /> Im if t am a large quantity generator,1 certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> Q to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> >- present and future threat to human health and the environment;OR,if I am a small quantity generator.I have made a good faith effort to minimize my waste <br /> CJ generation and select the beat waste management method that Is available to ma end at I can d. <br /> Z Pr eafXyped N me Sigoeture Month Day Year <br /> ot <br /> LLJ <br /> M <br /> T 17. Transporter 1 Acknowledgement of Receipt of Maiv;6a <br /> R <br /> Z <br /> A Printed/Typed Name Signature Month Day Year <br /> S J <br /> O P <br /> W O 18. Transporter 2 Acknowledgement of Receipt of Materials /d Name `� I \f J/ // /y, <br /> E rted,TYP`et\L i_f� 1. t-1 L s�t [ CAAl1-4 GS/, �QR� .. a -feaf <br /> Z_ l il`.t r f <br /> 19. Discrepancy L- 7 Space s y <br /> A <br /> 1 20. Facility Owner or Operalat Certification of receipt of hazardous materials covered by this mfest exc as noted in Item 19. <br /> T <br /> y I Prinied7Typed Name I==-- SignMnnfh <br /> DHS 8022 A(1/88) — Do Not Write Below This Line <br /> EPA 8700-22 <br /> (Rev 9.88)Previous editions are obsolete. <br /> f f'+- ' 171w TSDF"SEN PY TO GENERATOR WITHIN 30 DAY` <br />