Laserfiche WebLink
rim•-13-92 THI_t 13 : 31 _ P. a2 <br /> See Instru CtIOne on 8ack Page 8 Department a ContrHs-llol <br /> l Division <br /> 9fito of Calllomle--Neu!!h u•d Walters Agency !✓ Toxic Substances onto, Division <br /> Form Approved OMB No 2050--0039(Expires 0,30-91) and Front of Pag Sacramento,California <br /> Please print or type. Form deslgrwd for we on ekte(72-pitch fyV6wrffed.r's US EPA ID hloManileet 2. Papa'1 <br /> UNIFORM HAZARDOUS e`too 0 d O 3 (/1/ t is not required <br /> In the seeded areae <br /> WASTE MANIFEST at a not required by Federal law. <br /> 3. Generator's Neme and Maitkg Address A, awe McMNet Dooa ( Q f1 <br /> �R A/tr r,.� l o• 'S-n? jr'7 ^1 410 <br /> 0 ,sou _7 HaretA,.� F,'2 9. man GenenloreW <br /> a. Generator's Phone O-J i) $'t S 'r 7 f 1 <br /> Q 5. Transporter t Company Name 8. US EPA ID Number C. mea TnnaporliYa W <br /> // rMapatN'!1 <br /> 11/ <br /> T. Transporter 2 Company Name S. US EP ID Number H. StadeTrwpater'a 91 r <br /> I F. Tramponer'a Phone <br /> B. D al�antl Fe III lLma and 5116 AOtlreca 10. US EPA ID Number G. man Facws ID <br /> 6i 3 O/r �/ColT <br /> �rtrEA tor ! Gr-VD h, Fa�Ny'c PNonc <br /> ± 12. Cortalnen 13. Total .e. I-_ — <br /> 'o <br /> Quantity UIV Waste No <br /> 11. UB (Including Dsacrlpllon(Inuding Proper Shipping Name,Hazard Class, and 10 Number) No, Type WtrVd <br /> 7v m� L 3 <br /> pay <br /> N p^ yr/T/yjtAr /9i OD/4 state <br /> E b <br /> R E'PA1 Other <br /> A <br /> T ata <br /> c O - <br /> R c. <br /> l <br /> state <br /> d 1. <br /> = I I EpMrJlhn <br /> w <br /> U <br /> rot cMce LMtaa Agave <br /> %I J. DseoripNpea too aloft if All - a, Is. <br /> W IS <br /> N G i. �fv <br /> I` 15. Special ue^dllnp Inalruch a antl Additional Mfermelion �.'1 <br /> T R V 7 <br /> Z <br /> R, �tZol rLr � DOf I <br /> toandaccurao Mgping ataeiz <br /> GENERATOR'S CENTIFICATION: tend labeled.declare and e0etineoil raeDectcontents e In h Dropeus elcontlluon fognment r transport by highwayeacca ding to applicable intematlonnl end <br /> J and are elssslne4 Decked.marked, <br /> g nations,government requlalbns. <br /> W h I am a large quanhtY generator,1 teddy that I have a program n place to reduce the volume and toothyor disposalwt currently epzblte to me which Minimizes the <br /> Q to be economfeafly praeticeble and that I have selected the practicable method of treatment,Storage. <br /> present and tutors threat to human health and the environment ON.it t sm a small quantity generator,I have made a good nIM effort to minimise my wads <br /> s peroration and select the best waste management method that a available tqjne and that I can afore, Mo^th Day veer <br /> �.' Sionelur 1 <br /> PNdser Ty dName y <br /> ��p u r <br /> nKILL <br /> w t7 Transporter 1 Atknowledpemenl of Recatpl b(MaterlaU Month Ler— <br /> Year <br /> 9SignatureR14 <br /> A Primed,iyped,yllQa,�R y r ��C1.lN <br /> I` N R <br /> 1 P tis. Transporter 2 Atknowle egemenl of Recalpl ai Materiae <br /> O _ Month Day Year <br /> P ��Signature <br /> T Printed-Typed Name i <br /> U E <br /> to. Discrepancy Indicallon Space <br /> F <br /> A <br /> C <br /> i L <br /> I 20. Fecllllr Owner or Operator(7erliilCalion of reeatot of hazardous materials covered by this manifest a_xopl a nand in Nem 19. MuMh Dat year <br /> T —_ Signature <br /> V Frmted:Typed Name <br /> DHS 9022 A Do Not Write Below This line <br /> FPA 6100-22 8L,e, GENERATOR SENDS THIS COPY TO DOHS W iHi'• �� D:YS <br /> (Nov.8-W)prevleua ede.a��s are'1peaefe. <br /> r To: P.O. Bcz 400, Sofrdmnnro, CA 95812-0400 <br />