Laserfiche WebLink
Slate of California Environmental Protection Agency 6. Department of Toxic Substances Control <br /> Form Approved OMS Na.2050 0039{Expires 9-30-991 See I[15t�1lCt1pT15 OT1 bdC�C Of P Socramersta,California <br /> Please print or type. Form designed for use on elite f I2-pitch}t' r. Manifest Document 2. Page 1 Information in the shaded areas <br /> 1- enerafor's US EPA LD No. is not required by Federal low. <br /> UNIFORM HAZARDOUS of r` <br /> WASTE MANIFEST ql 0 <br /> J' A. State Manifest Document Number [� 7 <br /> 3. enerator's Namg and Mailing A'dd ress - AT T A�� � XV <br /> � 6624 <br /> a.l .it„•' } iaixYLs f,} r .331Jf '�fV j7irdal� <br /> 0'� "j 0474 3 G B. State Generator's ID <br /> 00 <br /> Ln 4. Generators Phone{3'Z-_*>) ZV 4200 , C. State Transporters ID Reserved.] <br /> c:t5. Transp�s1 ICI1 6. US EPA ID Number <br /> LO 4 8 D. Trans <br /> I m <br /> Oao8. US EPA ID Number E. STote.Transparter's ID]Reserved.] <br /> 7. Transporter 2 Company Name - - - - <br /> .�,� � 'F.'Transportar'i Phorie- - <br /> !U. �}g ¢� � 10. US EPA Number <br /> 9 _G,YSFdte:F.aci itj/i''ID' <br /> �a D3`i#rAl rFTq`ta��T� d v-! '' ``�5 . ? ; raid <br /> Parfaer, C a. 3648 <br /> )O T2. Containers 13. Total ld. Unit <br /> f `V <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) - No. Tye Quantity Wt/Vol !. Waste Number <br /> Stab <br /> tZ a.Non-RCCA Haze= .ca s ���ast� �..igait sed/ i P tail EPA/ he <br /> 3 G State <br /> E <br /> O N b. EPA/Other <br /> 60 <br /> 60 E <br /> N R% State <br /> A c <br /> o <br /> Q? O T <br /> EPA/Other <br /> R State <br /> Lu d. <br /> Z <br /> Z EPA/Other <br /> u.t - <br /> w K. Handling Codes For Wastes Listed Above <br /> J. Additional Descriptions for Materials Listed Above <br /> Z a. b• <br /> t <br /> uj <br /> x <br /> 15. Special H Ad r n irr r af' T Fa?v1- R0.S NCA 3'`4-E SPOIN'SIH': <br /> �}�i-'t" f le a-cz���� Gt5 Say-!3na.Jir��zit�r�ec�c�:��� (55`3) :�5-024i� <br /> Z N'10 <br /> Lu y <br /> r <br /> 16. GENERATOR'S CERTEFICATION: I hereby declare that th contents of this consignment are Fully and accurately 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 />' a If i am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined la be economically <br /> p- practicable and khat love 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 om a small quantity generator,I have made a good Faith eFfart to minimize my waste generation and select the best waste management method that is <br /> ce available to me and that i can afford. <br /> O f r �� Doy Year <br /> �„ Prirnte T ped Namer f-� Sign ore ✓, - s r �• <br /> tO' f ` <br /> ss.t T 17. Tran orter 1 Acknowledgement of ecei t of Materials <br /> Pay Yeor <br /> W LLIA Prjnle / ed NameUl <br /> Signator <br />{ P <br /> p 18. Trans otter 2 Ack'nowfed ament of Recei t of Materiels Month Day Year <br /> R Printed/Typed Name Signature <br /> T f9l.Lu <br /> E <br /> 19. Discrepancy Indication 5poce <br /> F <br /> AC <br /> f 20. Facili Owner or.0 erotor Certification of recei t of hazardous materials covered b this manifest ezce t os rtoied inMonth <br /> Day Year <br /> it JT Printed/Typed Name - Signature <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br />� <br /> Blue:_ GENERATOR SENDS THIS COPY TO <br /> pTSC WITHIN 30 DAYS. <br /> . <br /> DTSC 8022A{1/991 To; P.O. Box 400, Sacramento, CA 95812.0400 <br /> EPA 8700-22 <br /> 1 <br />