Laserfiche WebLink
Form Approved OMB No.2050-W39(Expires 931196) - See Instructions on bock at prge O. Department of Toxic 5ubsrances Comroi <br /> Pleom prim or ype. Form dn9rssd far use an slier(12pikh)n W. Socromemo,Calkomia <br /> UNIFORM HAZARDOUS 1. is US EPA ID No. Manifest Document N3-' 2. Page 1 Infamalion in the shaded groes <br /> WASTE MANIFEST CAD 0 9 5 6 5 4 2 7 3 7 ? 7 / of 1 ° °trequired by rodent law. <br /> 3. Go se at r,Name and Mailing Address <br /> RV Circuits m 7 <br /> n 916 South Center Street, Stockton, CA 95206 B sea=c.na a,a:,lD <br /> in A. Generation's"haw (209) 546-9219 I C I 1 <br /> S. Transporter I Company Name 6. US EPA ID Number I C. Stare Tmnsporter's D <br /> Univl nwiromil IC A 10 10 10 10 10 16111217 5�Tran:parte.':wham r <br /> 07-7 <br /> 7. Tromporrn 2 Company Nairn 8. US EPA ID Number E. State Tronsporler`s ID <br /> TU <br /> E. TrampoW <br /> r 's Ph. <br /> a <br /> �Z 9. Dasi9nuted Facility Nanta and Site Address 10. US EPA ID Number G. State,F«iliy's ID _ <br /> xee0 21st Century EM <br /> = 2095 Newlands Drive, Bast 41- ra<ry a Phone : <br /> 7� Fernley, NV 89408 INIVID1918101819151338 2760 <br /> n' 11. US DOT Description[including Proper Shipping Norm,Hazard lens <br /> C ,and ID Number) 12. Containers 13. TaM Id. Unit _ <br /> Na. Tiflis, Quantity Wt/Vol I. Wore Number��- <br /> oRQ, Waste Cmroeive TAclui.d, Acidic, ImIrganic, tea` 792 `t <br /> Nc NeoeS., 8, UN 3264, PG IIr(NitriciiSulfaric) j : EPA/00.r <br /> E <br /> 00 N Is. Stab1 71 <br /> 3 P <br /> E <br /> fV R EPA/Other <br /> m8T T C. $1a1G <br /> O <br /> R EPA/Other <br /> W <br /> Z d. Sob <br /> W <br /> (J <br /> EPA/ <br /> N <br /> ZMaterialsfor Maals feted va yr <br /> a ....6-154,,=< '.. <br /> W <br /> K <br /> a <br /> J <br /> a <br /> 13. Spedd ifaedFmg Imtructiam and Additional Infarmatbn <br /> Z Rear 3rot tive clothing as required 24 Tiour anergeicy Pune: 800-648-9931 <br /> FI2G f154 National m"aponse Center: 300-424-43802 <br /> W <br /> H <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the commis of this comignment are fully and accurately,described above by proper shipping nems and are classified. <br /> Vpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national gowmmem regulations. <br /> If I am a large qua" generator, I certify that I hove a program in place to reduce the wlume and toxicity of waste generated to the degree I have determined to be <br /> J economically practicable and that I have selected the practicable method of treatmem,storage,or disposal currently owilable to me which minimizes the pre"em and future <br /> Nthreat to human heabh and to enxir .t,OR, N 1 am a small quordity generator, I have made o good fath effort to minimize my waste generation and select the best <br /> wake marnegineent method that is available to me and Mat I can afford. <br /> /Typed Name Stgeature 4 MaNh Day Year <br /> �/"Z I r q �I r.w <br /> Z T 17. Transporter 1 Acluiviekidgement of Receipt of Materiel <br /> W M PrtrMd/TyPed None 7/�// "/ nmom <br /> j/.'�? ✓ / -�. DaY <br /> o 18. T 2 A of Molaria4 '� <br /> u T Primed/Typed Nome SipnaMun Memh Day rear <br /> O E <br /> Al 19. Discrepancy Indication Space <br /> V A <br /> A <br /> Z I <br /> — 1 <br /> L <br /> I 20. Owner or Certification of of hazardous marerbh<owrad Mnn manifM art a noted in Nem 19. <br /> T PriMd/Typed Noma Signature Month Day Year <br /> It <br /> DO NOT WRITE BELOW THIS UNE. <br /> DTX 8022A(1/95) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />