|
ara,u u.��, �. •� - -' Jee-ntauvkr,..•=� - t Sacrmento tmtrornto .
<br /> Forrr�ApproVed OMB No.2050-0039 Expires 9-30991 �� a
<br /> Please print or tylso, Form designed For use on elite(12 pikf f!y�_, Pa e-1 Information in thos haded areas
<br /> 'aerator's US EPA ID No. Manilest Document Ne 2' g is not required by Federal low
<br /> . 71,
<br /> UNIFORM HAZARDOUS '
<br /> WASTE MANIFEST ' ' 21
<br /> � - —0 ) •'�'zi - ( = �� - of-
<br /> StateMamfest bocument Number
<br /> "s Name and Mailing^Address r- - f/"�T�s �•A.jOr ao-� c+Uii'��.. Are "; - h 2�L�`'1
<br /> 3 Genera a sz, # a
<br /> t `at1•'v`�1Jt *S f ' l rJ�l/Y�6I1rtL Lk3yD iB5ra4e GenerafoF i ID h �' # i�2$ as S, r
<br /> OpA --
<br /> N' d'Generators Pheee � Z '1,�l0 -C,",25
<br /> tate fwna rfer a 1D e e 3
<br /> n yC a b 'UShhEPA IDNum6ar
<br /> U L� 1 v
<br /> fx
<br /> PECIA
<br /> " 4
<br /> P rnnsprl r�s ISD[Rdtr-eNd "gY P " r
<br /> 8 US E A ID Number', `b- State T e
<br /> Go `7 Tronsparter 2 Company'Nome
<br /> }� 4 fTransportersonet� _ n'r"r>* ��_ 'gam*,
<br /> fV G State Fiacdity stlb a( �
<br /> 9. esig pied F tility ame and Site Address 10 .US EPA ID Number �� 4 a } J
<br /> �Pareract "-- 14287 E. Matsu t
<br /> CVQ ; ;
<br /> Czi. 93b4B C`A L 0.0 0 '! 0 2 T 5 L
<br /> x 12- Containers 13 .Toto{ 14 Univ. r5r;n` ��r� �
<br /> v 11. US DOT Description(including Proper Shipping Name Ha;ard Class,and,ID Numkiorl No. T e Quantity. - Wf/Vol F Was a Numbers - r
<br /> tlVZ ' x_
<br /> a.
<br /> Nan A;lea c1=?��a east i iqWci (Ut~ l EPia�Orh'
<br /> r
<br /> F 6,
<br /> G
<br /> ci
<br /> o .N �
<br /> co
<br /> E00
<br /> EPA/Otkera a <
<br /> R.,
<br /> (V
<br /> -O T. - yEPA/iOther
<br /> i ,
<br /> _.
<br /> LU
<br /> v stdy� -
<br /> tk
<br /> d.
<br /> - - -
<br /> iu rsrr ",r�- a'e,y�.u'.rY 4-r -a y `� `" , '^.+'' fi IC-,tiandiingodes for'Wnsley,.lrsted'Aliove "� kg. _,,�,
<br /> +n -'. �ri'`honsfoThllaterfdls'!i"sFedAhove'Mxu � + a , � a �. .r..g. „
<br /> �`0 as,w' b..> -r �Y t sit
<br /> ar r>w,
<br /> �--'�' x.--''"lx^• - „4.1:�: ',ne ,.=r—i,',YM .v l k �V��r,�ri �` �:^7!-i'. �r -�"x l� `k 3iy,� yor' 'a a�+`- '4�.a ,�d.�, ,k4X -'L :�,,-S "`}a�"„�' +�''-;Y��r;"
<br /> '�:+•• :f!'3.r}, ,.g;y�v` �„^,rrry-'� ',-�,
<br /> � ,ir.r1 � s ¢ +,err
<br /> '�`` .ayr'r dl ;at.+�•i�-�'�s n �r���et;�i'^�n y, r' y{."� ,s°r`��#)� _R5'x _ w+•(t.,_ :x. x.,,.-
<br /> vt �'"`,`�" - :,-_,,,,11��55 .a r .JT�k . :��I',�` ; � .fir,3,u- �'� o-,'A?Sy.� N=` c"�sk'�- ��,,Fid - � ?'-� _-�'stst � .�-i'h.•s`nsrr?�.z:
<br /> W Vin. ..� -F•er`�-gz �f ,�i rba,;x,rrf�,.,a k, �.,;.c 4, `- �, yr-'es1 v,,, L ,}?,7!- .d,.'L"., ,.'s x-yd d-n�.x
<br /> -'
<br /> � .'�., ..a✓`+ t+^ .,�.r�;:r,a�r f.3,� �,.u-� �'"'4�Iu,.:,G'� r� �L-';r�yb 'rs�`�.�,.�-f�,J,. ✓ Vii:,._,, 'a�' ,3�'"" .3.. 'w r S.rt. � r.`a Sd?� *�y' '-';b,��" v �''
<br /> 4
<br /> _Q ,",��A„�,1��4'�'���kTPF ���ii .F'?�h}.�iti F �'I FF��k�dx1:�..K' ,h.t.,�,`-b���,Ft�C'r.� .Z.'..'n4-,�..n."r; 'a!uPTi'• i' .- -
<br /> v
<br /> Q 1,E5 ` d� �t'' ' " `. EN�MRCE CY RESP(�N E
<br /> a San Jfasi�in Frt�r Recrclitg (559}4�� 020
<br /> 7-
<br /> LU i77��Cr►` iJ�. vG �c, s
<br /> c(52 t, Z+ 1` -1 �S{J
<br /> l 1 G, GENERATOR'S CERTIFICATION: I hereby'declare that the contents of this consignment are fully and�accurataly described above by proper Shipp'ing name and are classifred packed
<br /> F'- Q. marked,and labeled,and are in all respects in.proper condition for transport byhighway according to applicable international and national government regulations
<br /> - v delermrned
<br /> fit b
<br /> e econo
<br /> mtcal
<br /> ` d
<br /> toxic of waste. enerated ro The degree I-ha e yy
<br /> i a ro ram m lace to reduce the volume an y 8 health
<br /> i that I hove g P ': `ol to human
<br /> I cert future': e
<br /> � If Lam a large quoin generator, certify P i availa6le.to-me which minimizes the present and foto
<br /> f — generator,
<br /> selected the rattfta6ie rireihod oF,_treatment,storage,or disposal current.y, ,
<br /> a i able and that I h nand select the best viasta management_method-thcf is
<br /> rad ct-minimize m waste eneraho
<br /> P good faith eFfort o. y g
<br /> ' z and the environment;OR,if I om a small quantity.generotor,i have made
<br /> i O available to rime and that I can afford. - - ,
<br /> Signal re Month--.=:'Doy, Year-
<br /> Printed/Typed Name 1
<br /> Z
<br /> T 17. Trans orfer:l Acknowledgement of Receipt F Materiols Month Day, Year
<br /> E A Pri /Typed Name Sig _ure1
<br /> l U' R rl _ '
<br /> JJ 44 t - _
<br /> 1
<br /> aLKG
<br /> lW P, � _
<br /> I
<br /> 0
<br /> 18. Trans orter 2 Acknowled einem of Recei t of Materials Month .: Day. Year
<br /> .tura - -
<br /> Si ria - - -
<br /> j O T Printed/Typed Name-
<br /> E u? R -
<br /> ` U' .:. .19. Discrepanty Indication Space - - - - -
<br /> i 20, Facili OrJner or'O'eraior Certification of recei i of hazardous materials,covered b this'ma ' axle t as t49
<br /> in Item 19. Month :Year
<br /> Si ure - - yd-
<br /> -'T Print / yPed Name - -
<br /> Y d.
<br /> RITE.BE
<br /> LOW THIS LINE.
<br /> T W ,
<br /> ONO -
<br /> 'D ,
<br /> F Yellow TSDF:SENDS,THIS COPY TO GENERATOR.WITHIN,30-DAYS: .
<br /> (Generators who submit hazardous waste for'transporf out of stole,,
<br /> DTSC 80224(1/99) P completed copy of this copy and send to'dFSC within 30 days]
<br /> fI EPA 8700-22
<br />
|