Laserfiche WebLink
State oL veor.email Pimmoice Agency ... <br /> Perm Ap No.2050:-0039(flpi ,9-WA) See Instructions on back of page 6. Depatm«e of T..ic Sb...Cam, <br /> .•Mw <br /> F. &*(12p&h), 4ft, __ -. Sacrament.,Celif.mwo <br /> i UNIFORM' F,�AZARDOUS rabr's US EPA ID No. Manilas)Document ti' 2. Pape 1 Information"n the shaded omen <br /> WASTE./$ANIFEST .` CAC 0 0 1 0 1 7 8 1 6 6 7 3 6 of <br /> ls no required by Federal kw. <br /> ..3.Garerec is Net and Mailing Address - - .. ... •t* <br /> n FEDRAL EMERGENCY MANAGEMENT AGENEY � <br /> n 600 ST., S.W. ROOM 607 WASHINGTON,._DC. 20472 <br /> 1 <br /> h <br /> 4. gra«',Ph. 12021 64673061 <br /> hS. Tronspo~1 Compary Nome - - 6. US EPA ID Number - } <br /> a <br /> m K <br /> P M 1 <br /> A- roes rbr 2 Company Noires 8. US EPA 10 Number <br /> IU <br /> 1 , <br /> Q 9. Dedgnatad Facility No.and Site Address 10. US EPA ID Number <br /> Z REFINERIES SERVICE <br /> leo 13331 N HWY 33 i <br /> l Q PATTERSON CA 95363 ICIAIDIO1813111616171218 <br /> 1 U - 14. Unit <br /> 1 Z 11. US DOT Description including Proper Shipping Name,Hazard Clou,and ID Number) No.12. C.ri2 n 13.Total <br /> T Wt/Vol <br /> NON RCRA HAZARDOUS WASTE LIQUID s " <br /> G ( T I T Q(10y16 G 3.w <br /> E <br /> m N b. <br /> m E <br /> r R . <br /> v A <br /> T c. <br /> co D <br /> W <br /> Z <br /> U � � <br /> N <br /> Z <br /> O <br /> w ' +' <br /> W <br /> K <br /> 0 15. Specid Hasdgisp kMrsrctiaas arid-AddiliacI Information <br /> USE APPOAPRIATE PROTECTIVE GEAR <br /> Qeye,- Lott-4 ti,,,f <br /> Z DESIGNATED FACILITY EMERGENCY CONTACT i1 (BOO) 874-4444 . '<.i <br /> = GENERTOR EMERGENCY CONTACT S (202) 646-3061 .St�c�l+„ y C� <br /> � 16. GENERATOR'S CERTIFICATION: 1 hereby decks that the conbna of the consignment on hilly and accurately described above by proper shipping name and are ctossilied. <br /> Q pocked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,stab and international laws. <br /> u <br /> If I am a large quantity generator,.)certify that I have a program in place to rad."the volume and toxicity of waste generated to the degree I how determined Io be <br /> .d aconemicalty practicable and Mve <br /> at I ha -selected the procticable method of meratmee,acrage,or dispoal currently aveikble to me which minimizes the present and lutune <br /> 0 threat to human health and the emnimmetee,OR, R 1 am a .11 quamity generator, I lave mode a good faith effort to minimize my waste generation and select the bear <br /> a, wade manogetintent medal the Ao,,oileble to me acrd that I can afford. <br /> 0 Printed/Typed Name Signa , �; .J .. Month Day Y <br /> F4UL4, <•Lirp'1 eK; an a.cn- 4 o' FfHA rx f )vim <br /> 17. Trompeter 1 Acknawi cl emeM of RKei0 of Materials <br /> Vr ♦ Printed/7Y / SiprcNro Month ]D <br /> 7 I ? <br /> W , <br /> f o I8. Trans Mr 2 A<krawled ement of Receipt of MMoiels <br /> W T' <br /> Printed/T Nome SipnoNn AbMh Day Year <br /> W <br /> O i <br /> N19. Discrepancy Indication Space <br /> Q F <br /> U A <br /> Z C <br /> I <br /> I <br /> 1 20. Facility Owner or Operator Cerii/kalion of receig of hazardous materials covered by this manifed agcoat as noted in Ilam 19. <br /> T Printed/Typed Name Siorclun ._. .. Morels Day Year <br /> Y P14-1- K <br /> DO NOT *KITE RKO.W ,THIS.}INE. <br /> DISC W22A (7/92) - t� <br /> EPA 8700.-22 Green: HAULER RETAINS <br /> s <br />