Laserfiche WebLink
51ateoff..atfromma earin■norrenaroAgency'•.. '"f :S.L �- -. Llepartrttent Of Health 5,. <br /> 4, Form Approval OMS Na.2050—OM iExpxea 9fI ,"fr k 'r; , Toxic Subafancsa Can"Di <br /> as print or type. (Form designed for use (12-pMch fypewrfferl. 7 tit. ,? .T_ ,.:_ sarramemo.Cali <br /> UNIFORM HAZARDOUS 11. G tinator's U3 EPA fD IVO <br /> . y Information in the shaded areas <br /> WASTE MANIFEST A 1 i, ? off 6 not required by Fedeial 1nr }t <br /> 3, Generators Name and Mailing Address } t <br /> TRI VALLEY GROWERS PLN7 T - r�, <br /> 26200 NOWELL RD t : Tit I <br /> Ttt THORNTON nc �^in w �.yn�f GA 9 v+6B6 flenerataraJD <br /> 4. Generator's Phone eG ) / 4—R+s�,.r.a <br /> E- Transporter 1 Company Name 6. US EPA.ID Number G$ .Ttansporter'a Q <br /> A W209 545-1011 <br /> Tre <br /> n <br /> 7. Transporter 2 Company Name 8. US EPA ID Number _ F,{abate Tranaportara q ':••r.:*[ <br /> F.-Tin rt!Por"W'a Phone r7a` <br /> Q. Designated Facility Name and Site Address 10. US EPA ID Number r PL,SiaH FrcNlty r D <br /> SAFETY'-KLEEN CORP. 7-183--01 �-` ' `. , ; <br /> J r,"S, - � .T <br /> U 5050 SALIDA BLVD L -`'� •��r� .� <br /> 4 CAT 0 yl S7 <br /> / C3 12. Container f3. Total— 14. <br /> UL <br /> l LL t t. US DOT Description(Including Proper Shipping Name,Hazard Claea.and ID Number) Oaantlfy Unit Waste No, <br /> 4 No. Type WI/Vol <br /> (O U WASTE PETROLEUM NAPHTHA star. 741 <br /> C3 COMBUSTIBLE LIQUID UN1255(DOQ1 ) (ERG 0x27) DM ��j P EPAlotner, <br /> E ,Tn�. <br /> AA <br /> N �-<I irti.Alf; <br /> E b- <br /> R <br /> y- <br /> T EPA l Other <br /> a p <br /> R c. State <br /> �Y <br /> EPA/Other <br /> _ �r <br /> H d Slate <br /> Z <br /> w , <br /> U - <br /> EPA!Other <br /> tt1 <br /> U) J. Additional Descriptions for Materials Listed Abo" �, i <br /> Z t :� * 4 - k Nandlinq Codas for Waslee Listed Above <br /> tu <br /> d. _ <br /> �r, � p +i ter`.re stir <br /> f 15. Special Handling Instructions and Additional Information <br /> Z 9037 L9116177115129202 7-183-01-3077 01 <br /> L, EMERGENCY RESP**-7038-888-4660 <br /> SKDOTM A: s01 B: C:, D: <br /> Q 1B. <br /> U <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> J and are classified,packed.marked,and labeled,and are in all respects in proper condition for transport by highway according to applir-abin international and <br /> EL national government regulations. <br /> N <br /> « If I am a large quantky generator,I certify,that I have a program in place to reduce the volume and toxicity of waste generated!o the degree I have determined <br /> - O to be sconomicalty Practicable and that I have selected the practicable method of treatment,storage,or disposal curcantly availabl4 to me which minimizes the <br /> } present and future threat to human health and the environment;OR.it I am a small quantity generator,f have made it good faith effort to minimize my waste <br /> generation and select the best waste management method that is available to me and that I can afford. <br /> Z <br /> LLI PrinledlTyped Na Sign Month Dey Y .r <br /> W <br /> WT 17, Transporter t Acknowledgement of Receipt of Materials <br /> R <br /> Z A Printed/Typed Name <br /> Signature <br /> q A h D r <br /> " <br /> LL C,J Noel Thornton <br /> O p <br /> LU O 98. Transporter 2 Acknowledgement of Receipt of Materials <br /> ¢ R Pnnted/T ed Na a Signature <br /> U E Month Dry Yea <br /> Z R ' I _ <br /> 19. Discrepancy indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by.thla manifest except as noted in Item 19. <br /> T <br /> YPrinted/Typed Name Si nature Month Day Year <br /> g <br /> Clark E. Hill I <br /> DHS 8022 A(1 Y88) Do Not Write Below This Cine <br /> EPA 8706--22 <br /> (Rev. 9-88) Previous editions are obsolete- Blue: GENERATOR SENDS THOS COPY TO DOHS 'NITHiN 30 DA.? <br /> To: P.O. Sox 400. Sacrcmento, <br />