|
06/26/2004 11:20 209858J18 KYLE
<br />,om of Calif ... Prol.ficur Age 71 — 1 —01 See Instructio):6s'on back of JQ
<br />.0cy
<br />=,nned OMB No. 2050-0039 (Vm'i�30-991. 6.
<br />at.rnm.. Form deliAead
<br />I
<br />t
<br />PAGE 04/04
<br />Depararemi of Toxic 5ultstgunc., C. Or.
<br />California
<br />VTK 8022A 0/991
<br />EPA MO -22
<br />13b NOT WRU BEL qWFDff�,'.L
<br />TOR WITHIN 4 DAYS.
<br />TT Y'A.754)$E!, T, L� ;iNEi,,
<br />Cknoraicre w6 aubmil hozandoot-waFte, for traru�perf O.J.0f-stc0e,
<br />pr.�uco.cc;inplolod appy of 1114 copy,and:sancf, to DTSC within 30 'Int! t
<br />1. Generator's US EFA ID No. Manifest Deeumenl No
<br />9 T Information in the Acclecl or.,
<br />YNIFORM HAZ4R00W,,,r-"'
<br />A -.t C
<br />is at required by F.d.ral I.,
<br />WA
<br />of
<br />3., Osmmlor', No.. and Nulling Addrins 1- 1-101.) F, i" H I- ,�'d I P- 'A.
<br />31als Maniforit
<br />n'
<br />B. Sicris Generator's fl)
<br />G.r.'emor" Fhaha I
<br />5, Tran,ip"e I Company Nal i,i 6. US EPA ID Nomb.,
<br />-Ii�-EEN SYSTEMS, 1 NC
<br />v 1- kj 'i
<br />0�. Trontporracm,5 Ph a
<br />--57'4Q
<br />n' 11
<br />T. Trvnsp �or 2 C:.Mp..y NOW il, US EPA ID Number
<br />Tra
<br />frontlet:PH'
<br />I
<br />b.
<br />9. Des cip.ciliv,1TJ l., 10 US EPA ID Number
<br />P V.- 1
<br />G, Stale;Faccil c�i'�l i,
<br />�TH STREET
<br />8�
<br />tl!3 000C)e4,17
<br />H. Facility's
<br />4 11
<br />Proper Shipping N.M.. Hcucard Clan,, and! ID Numbers
<br />12. containers
<br />13. Total,
<br />unit
<br />I:'
<br />11. US DOT Derm,lptiom m4ding
<br />Quantity
<br />WI/Val
<br />""Watt'6'
<br />WASTE, L. T. (i .i rn,
<br />N,
<br />.;C r. 71
<br />LRAVE -,;QLUT f 01,41, c!'4. j
<br />N
<br />E
<br />R
<br />A
<br />T
<br />0
<br />d.
<br />State.,
<br />J. Additharral Dationlit.1lontf-rM3jihid Aboveall
<br />01 V, j.U4*At,%0!AJ/ QV. W.Q
<br />7t(; 24HR
<br />x,,1 -T HOP t ZED TO R ETA 'N 1.14'EN9F-D SUBSFOVENT CARRIER, AS'4 EPWY.
<br />A 6.39 B :C:fJ
<br />i
<br />16. GENERATOR'S CORTUPUTION: Ite lyiecledor. that 1ha contents of Ph4,..4Ty..iar* fully and croccr6t de,tri6edob�6.yppor,hipflho"meand ... cl ... illml,P041,44,
<br />marked, and 1.6oled, and or. In .11 rn ',w, in proper ;.rchli.r for fleumporl lhiqlr� according to Mo. icablo international and notionq gomr-nmeni
<br />If I om o large quontill gone, coar, I c*rtift, that I ve a pro rom rm.pIdda to mcluve 11,ovahtere dMd itmild f wmie generated to dist.,nalned
<br />nily Mra; 616,10 me which roinirrigas l6ji�rjjvn1 and Toun, Orval at human humit
<br />I ham alecied the mashed a ? 1hiMInt, storage, or, dlilactial"citurr; �.
<br />practicable and the, procticabl. ,
<br />.
<br />and the environment, OR if I am a vroll quantity geruvalMr, I here made a qocxl�faith Offorn 16-minlrelmnq .to g&Aarallor, and F.I.Ct ,
<br />amlialal, no Me and than f can afford.
<br />Priprud ,.d No"
<br />ba? YeozC.
<br />17—Wons verflir I Acia, arrant of R.c.1,1 .1 Moudirials
<br />?6.rM1/Tylg#(Name
<br />1 a Tram ria, 2 AcknowedqMnom of lbec-it;t I
<br />Y..r
<br />T
<br />Pr;mt4d/Typ-d N--- Signature Y
<br />E
<br />R
<br />19, Discrv,Pamry Indication $Poor
<br />F
<br />A
<br />I
<br />. 2D. Eadli Owner er rota L.niRcolion of ronl of hazardous mote els n h T fe to .Ld.n Item 9,
<br />wvft
<br />Qum r n
<br />VTK 8022A 0/991
<br />EPA MO -22
<br />13b NOT WRU BEL qWFDff�,'.L
<br />TOR WITHIN 4 DAYS.
<br />TT Y'A.754)$E!, T, L� ;iNEi,,
<br />Cknoraicre w6 aubmil hozandoot-waFte, for traru�perf O.J.0f-stc0e,
<br />pr.�uco.cc;inplolod appy of 1114 copy,and:sancf, to DTSC within 30 'Int! t
<br />
|