Laserfiche WebLink
' T <br /> Department of Toxic Substances Control <br /> tate of Cdlifornia—Environmental Protection Agency <br /> See Instructions on back of pag Sacramento,California <br /> arm Approved CrAB No.2056-0034(Expires 9-30-99) -iter: - - 2 pa e ; information in the shaded areas <br /> lease print or type- Form designee)far use on elite(I2-pitch)Y ManiFest Document N g is not required by Federal law. <br /> 1. -eneraor's US EPA ID No. � � � � � <br /> UNIFORM HAZARDOUS of <br /> WASTE MANIFEST � r i A, State Manifest Document Number ¢/q� <br /> y L F ]«d +w�1,. 247 522 <br /> 3. Gert rratt rtr a �;d Mailin ddres <br /> +ie✓+i S � B. State Generator's ID <br /> r <br /> A. Generator's Phone�,).. 1 ffi*[} <br /> � 6. US EPA iD Number C. State 7ransporter's ID IReserved:] <br /> V 5. Transporter 1 Company Namer;•-• k t F _ ,; ': - <br /> n DT <br /> . ranspo LOt;,s3 0 <br /> 1 � U�x; SiafaTraIts parI r',ID ifteserved.l <br /> o <br /> 8. U5 EPA ID Number <br /> 7. Transporter 2 ompony Name <br /> F.'Transporters Photie', <br /> i Q G .'Strife Facility's ID <br /> 10. US EPA ID Number <br /> 9- Designated Feciiity iNamo and Site Address? <br /> 1 2 F M=Iiing - H. .F66lity's Phone , <br /> jD <br /> Z is - k <br /> °Cg 'd <br /> 0 P*rlie- '4 s 12. Containers 13. Total 1b- Unit _ <br /> u. ' <br /> No. Tye Quantity Wt/Vol I Waste.Numbai <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) Sfafe, <br /> Za, <br /> � J, d �T EPA/Otfe�(t <br /> r ]ti i <br /> IQ�g 1�'c CU L-t r` s� �s � i; t state <br /> Nb. EPA/Other- <br /> m k <br /> I� it state <br /> f A <br /> 6. T EPA/Other <br /> I R State <br /> x <br /> w d. <br /> a EPA/Other <br /> 2 <br /> w <br /> I U <br /> K. Handling odea For Wastes Listed Above <br /> w <br /> tV2-1: IJ. Additions!Descriptions Far,Materiafs Listed Above - a. `•1, F b. <br /> 01 <br /> d. <br /> r J <br /> a <br /> Z 15. Special Handling Instructions and Additiondl Information '' '-r � "»' �• <br /> r ' 7 CCO <br /> f ' <br /> z <br /> f <br />+ gnment are Folly and accurately described above 6y proper shipp <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consiIng name and are classified,packed, <br />`[$ V marked,and lobated,and are in aft respects in proper condition for transport by highway according to applicable international and national government regulations.. <br /> S to the y <br /> d If I praeconomic <br /> cicablerandgthaFll have a <br /> of treatmrogram in enlace to reduce t,storage,or d spa all currently ovaii;a6le to generated <br /> m�imizes the present and fumtre threained t tohuman he <br /> f and the environment;OR,if 1 am a small 4uontity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> c1c available to me and that I can afford. <br /> t Montrf Day[ Year <br /> 0 Signature' "" 3 " <j <br /> PrintedLTyp�Name _-_. i �' 3 �_ � i <br /> w T 17. Trans aria-1 Acknawfed ement of Recei t of Materials i Mont _'Ray Year <br /> 0 Si naturB ��` 1i ,}r d <br />} W Printed/T ped NameA <br /> i ii Q 1 S. Transporter 2 Acknowled ement of Recei t of Materials Month Day Year <br /> 0 1 Printed/Typed Name Signature <br /> LU <br /> E <br /> t Q R <br /> i V 19. Discrepancy Indication Space <br /> Z <br /> s A <br /> C <br /> f 20. Fd/TypOwName ner or O erator Certification of receipt of hazardouSignature <br /> Printed/Ts materials covered b this me iFest exce I as noted in-Item 19. Month Day Year <br />{ <br /> j ed <br /> I ityY <br /> DO'NOT WRITE BELOW THIS LINE. <br /> I <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC w1THIN 30 DAYS. <br />! To: P.Q. Box 400, Sacramento, CA 45812-0400 <br /> DTSC-8022A (1/99) n <br /> EPA 8700-22 <br />