REMOVAL_1989 - Laserfiche WebLink

Home Browse Search

Stale of Cahlomm—Health and Welfare Agency Department of Health Services Form Approved OMB No.2050039(Expires e�q Toxic Substances Control Division Please print or type. (Form designed for use on @life(12-phch Yypewriler). Sacramento,California UNIFORM HAZARDOUS 1, Generator's US EPA ID No. Manifest 2. Page I Information In the shaded erste Odo rhamt No. WASTE MANIFEST Cld Cl0 1 . 7 of I is not required by Federal law 3. Generator's Name and Mailing Address A. State Manifest Document Number B J J Company 2431 E. Mariposa Road 89642438 Stockton. California 95205 B. State Generator's ID 4. Generator's Phone(209) 941-8381 1 n 5. Transporter 1 Company Name 8. US EPA ID Number C. Slate Trensporter'e ID n ^ DI LL IRD TkUCK1NG I cl A ill 91 N 11 a U j j D. Treneporter'e Phone 1 11151N m 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID F. Transporters Phone 9. Designated Facility Name and Site Address 10. US EPA 10 Number G. State Facility's ID J Erlckson, Lu' . p< 255 Parr Blvd. H. Facility's Phone n`) Richmond, Ca. 94801 CfZ '+ ; 1111711 \.� 12. Containers 13. Total 14. 1. W 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. No. TYPe Wt/Vol t,p a. State 512 F)Z G IydSLe Empty Storage 1'ankb_ �� E California Regulated Waste Only T i EPA!Oha Una 3 N E Is. State cV R A al T EPA/Other v O g9a R C. Slate `Y EPA/Other W d State 1- Z W Q EPA/Other w = J. Additional Descriptions for Materials Listed Above K. Mendlinp Codes for Wastes Listed Above One 500 gallon tank *3012. Last Contained b. w gasoline. bne 12.000 gallon tank *3013, a Last contained diesel. Both tanks dry Iced C. d < at 15 pouf)-da per 1.000 gallon capacity. Z 9 P 15. Special Handling Instructions and Additional Information Z Keep away from sources of Combustion and wear hardhat safety glasses, steel toed boots and p)'otective clothing J FFR 9 a n J GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and ac1T V1j Mhf* UihUjA6rWj)kpl ilq name and are classified,packed,marked,and labeled,and are in all reapacls in proper condition for transport by high pp�pppq!{nW1a 1I q.U)�aintlonal and Nnational government regulations. 111 am a large quantity generator.I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined 0 to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which mmimizee the > present and future threat to human health and the environment;OR,if I am a small quantity generator,1 have made a good faith effort to minimize my waste Q generation and select the best waste management method that is available to me and that I can afford. WW7 Printed/Type Name// % Signature_ �. Month Day Year W s 7A _ .� ) wT 17. Transporter 1 Acknowledgement of Receipt of Materials ZR < A Printed/Typed Name Signature Month Day Year 0 5 /3rtiAnl MArNEcvl A �� ` O P O 18. Transporter 2 Acknowledgement of Receipt of Materials W a R Printed/Typed Name Signature Month Day Year Q E 2 10. Discrepancy Indication Space F A C I L I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. T y Printed/Typed Name Signature Month Day Year DHS 8022 A(1/a8) Do Not Write Below This Line EPA 8700-22 (Rev.9-88)Previous editions are obsolete. YELLOW: GENERATOR RETAINS