Laserfiche WebLink
trate or l0111(unl -[nv ronmental ProRclrm Agency <br /> ������d <br /> No.2050-0039(Expires 9-30-991 See Instructions on back of page 6. Department of Toxic Substances Con <br /> P eoT u prim«tOMB form designed for as m A&112-pitchl svoewritnr. 606195 Sacramento,California <br /> Is 'emralor's US EPA ID No. Manifest D«umen,.w 2. Paget 1.6rmalion in the shaded areas <br /> UNIFORM HAZARDOUS nal required by Federal few. <br /> WASTE MANIFEST CAT 018101012141719171 8 2 0 9 5 aF 1 <br /> 3- Generato,s Nome and Mailing Address - r umber <br /> PACIFIC MJ _ - 2 2 0 9 5 ,,.- <br /> o PO BOX 5095, ROOM #3D000 <br /> - -- <br /> (9Z5 )B 3 s. <br /> - � .- ca"aro1ar, Pb.,ne$AN BAlIOII CA 94583 2 �6$G6 <br /> PHIPfF1'e15ANBPORrATION & 6. US EPA ID Number fie- 1DtH "r*748 �c* <br /> r m <br /> o FdMMIATION, INC. CAD 0 6 3 5 4 7 9 9 6 , J4 <br /> 08)268-1196 s -' <br /> m 7. Transporter 2 Company Name 8. US EPA t0 Number - rsporf¢r4 ID fR,asetl - - <br /> -%r- <br /> Q �gKu.@hme <br /> U 9. Desigmled Focilily Name and Sita Addrms 10- US EPA ID Number ' <br /> SEE Rtr. FRctc-t'� �„ ' <br /> Z (3o2c S <br /> JV 0 <, <br /> y J <br /> _�1 12. Cmtainxrs 13_ Total 11. Un t <br /> �P 11. US DOT Description(unlading Proper Shipping Name,Hazard CJoss,and ID Numbed T pumryh, WI/yd f•W astc N F �. <br /> "9 = YASTB FLARABLB LIQUIDS, I.O.S.1GASOLI116, DBLSKL), 30!1993 PGII , •..:: 213` <br /> 3 G RQ (0018) SAGN1281 p p ' T T G <br /> E <br /> less as N b <br /> no E <br /> r R <br /> a A <br /> o T C. s'}: <br /> r m R <br /> W <br /> sjrr,MateagliLi z '' � <br /> �--` d <br /> z15. Spedal Handling Iro—t s_and Addinmal IafarmaM1on <br /> ITrV AD1R655 <br /> Use Q BHBAGSOCY ASSPONSS CALL f8001 917-7701 3js is tA %I.LG-AP AVq. <br /> z GR <br /> Its <br /> 16- GENERATOR'S CERTIFICATION: I hereby declare diet the cmtents of dais cros�'g"mans are fully and accwal,4y described a6ave by proper shippingmme and ore classified,packed, <br /> rk <br /> V maed,and labeled,d,and are all ells respun proper condition far transport.Ey highway according to applicable international onal and notiol government regulations. <br /> If 1 our o lar amfi tor,1 cern that I have a r ram in lace tared.the volume and toxicity of waste ted to Bne'd rex I have determined to be economical! <br /> card <br /> 9 8 y pro P N which e8 <br /> N and the tale arm that I have I steal the practicable generator, <br /> of th.. ad storage,or ilh effort <br /> currently available so ma which minimizes tel select <br /> present and future threat to human heal <br /> r oral the environmenq OR,if 1 am a small quanfiN generator,1 Gave made a good leilh affoA b minimize my wade generation and soled 8se bets waste management method that is <br /> m' eveit.M.to me and that 1 mn afford. <br /> OPrink Typed Name. Month Day. Year <br /> Z <br /> r W T 17. Transporter I A<kmwllled ement of Receiptd Materials <br /> E E P 1`syJ¢a a FJ .F 3lgnaiii a Mmlh Day 171101--- <br /> :E <br /> .- <br /> S ec>"T s2sSEAU <br /> LL if 18. Tramornouler 2 Acknowl ent of Receipt of Materials <br /> 0 T Prunkd/Typed Name signalore Month Day Year <br /> W E <br /> (J 19. Diure <br /> C <br /> � cahon space <br /> f �aQQpp i/ <br /> z 4 a7 Firrti nn t ggy� EQ f t flTTL� d fironm win I s: t <br /> 1 <br /> 20- F«ulu na or Cerfificafim of recei t of hazardms materials covered naniFe--ez --ted:—.19.t <br /> Ise T Pri yped Name e Sign Ly Month Day Year <br /> r <br /> C Z�L ATLWO DO NOT WRITE BELOW THIS LINE. L Z 3 9 Z <br /> White: TSDE SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) To: P-O. gox 3000, Sacramento, CA 95812 <br /> EPA 8700-22 <br /> r <br />