|
------------------------------ --
<br />state of I Store of Carif°r'"a—Emmon ""°' P,w.,,pFn Ayenl�qw.'_. • -- See Instructions on"odock of page 6.
<br />Form A� From Approved OMB Ne, 2050-0039 (E;i v. 9.3D9A)
<br />P^^t or ryP•.
<br />em Po d d 1 r use on Niee (12pirchl rypse+imr
<br />�z �Z
<br />0 ^C
<br />)O u
<br />)U
<br />)Z 07
<br />>3 G
<br />N E
<br />00 N °
<br />C? °
<br />E <
<br />R $
<br />A c
<br />c
<br />C? O
<br />°
<br />Zl
<br />Z AW
<br />C7 M
<br />z s
<br />W P
<br />o
<br />W T
<br />O F
<br />W `
<br />Q F
<br />U A
<br />Z t
<br />L
<br />1
<br />T
<br />Y
<br />Depanmen. of To.ic SubnaM,
<br />5.mane,te, C.M.—
<br />Pleaw
<br />Nm eepne .
<br />1. Gmterator's US EPA ID No. Manifest Document No. 2. Page 1 late nnvhon kt tlm shoded am
<br />UNIFORM HAZARDOUS is not required by Federal Imn
<br />WASTE MANIFEST c.1 AlC1 0101 1101 5121 1 3 E 1 0 e B I 8
<br />3. Gnnmomr's Name m,d Mailing Addrms RAYMOND !•PHRd�OMPE11114-
<br />II.
<br />2245 W. CHARTER WAY x
<br />STOCK: rON, CA 95206
<br />A. Generator', Phone ( j (209) 466-8804 .- -
<br />S. Transporter 1Co parry Name 6. US EPA ID Number,
<br />SHOP HAZARDS SOLUT 1 INJS ICIA1016101015114169
<br />7. Trompotier 2 Company Name 8. US EPA ID Number e %
<br />—3 arm
<br />.9. Designated Facility Name and Site Address 10. US EPA ID Number
<br />STATEWIDE ENVIROIVENTAL
<br />12618 MAIN STREET
<br />LOS ANGELES, CA' 90061 ICIAV01010101elB 2 5 2
<br />12. Camainen 13. Total Z. ld. Unit
<br />11. US DOT Description (mcludirg Proper Shipping Name, Haaard Class, and ID Number) No. T �- Ouoatiy"='' Wt/Vol
<br />RQ, WASTE FLA144ABLE LIQUIDS, N.O.S., (GREASE, —
<br />G TAR): 3, UN1993, 11 (DO01) 01011 D M 01611 P _.
<br />E
<br />N b - -
<br />E RQ{` HAZARDOUS WASTE SOLID, N.U.S., (LEAD,
<br />R CHROMIUM), 9, NA3077, 111 (D00E. D006, D007) 0 0 1 D M 6 p
<br />A
<br />O RQ, WASTE PESTICIDES, LIQUID, TOXIC, N.O.S...3
<br />R (OIL WITH. DDT)., 6.1, UN2902,-11 (DDT) 0101 1 D.A fJ P-�
<br />d.
<br />i X. WASTE,OXIDIZING'SUBSTANCES; LIQUID, N.D:S-, "--
<br />1 5. 1, UN3139, It 0101 1 DI
<br />% hj9 "naT: �, ends Yisied'-A ., •T.:� e�,.. ;.l(F>Naid "':V-Iastn ��
<br />1
<br />r 2.
<br />15..Spedol Handing InmucSions and Additional Informntioq24 HOUR EMERGENCY RESPONSE NUMBER 1 (800Y 399-4357,
<br />i 11A. PROFILE #26607-A 11C. PROFILE #26638-B
<br />T 11B.. PROFILE #26606-A 11D. PROFILE #26635-8
<br />16. GENERATOR'S CERTIFICATION: I hereby dewts
<br />clare that the mm�of this comignmem arc fully and a«urately described above by proper shipping name oad am dmds
<br />= packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and rational govemme t , �latia
<br />_!_._....;.•vas-�
<br />If 1 oat a large quantity generator, I certify that I have a program in place to reduce the volume and tonicity of wage generated to the degree Phase determined L
<br />monamically practicable and that I have selected the pmcble method of treatment, storage, or disposal currently avoilabk to me wFid,'mkimrses the present and h
<br />tfro
<br />n throat to human heahb and the emiramnent; OR, if I oat a ..It quonM'y generator, I hove made a good faith effort to minim too waste generation and seka the
<br />woste management method that is available to me and thin I oar afford. ON BEHALF O RAYMOND AGA 1 CULTUNL'
<br />Primed/Typed No - SignatureMor^,: Day;:.:
<br />W. V. M f, 11 J 1 0
<br />'d 17. Trans rter 1 A<knawl, ement of Remi of of Moterioh - -
<br />u• .
<br />w Printed yped Name SignaNrc Month Day
<br />Y L
<br />L
<br />0 18. Transtoorie, 2 Acknawkd of Recei t of Materials
<br />w r Printed/Typed Name Signature Mpndlt •-c Day _•
<br />L F
<br />o
<br />W 19. Discrepancy Indication Space. -
<br />'nF
<br />Q _ 11
<br />U A
<br />L
<br />' 1 20. Facility Csmr or Oruento, Cartificotion of reatnot of hazardas materials rovercd by this manifest except as noted in Mem 19.
<br />T Pri,"d/ryp°d Name Signowm Month Day. -.
<br />Y
<br />DO NOT WRITE BELOW THIS LINE.
<br />DTSC. Hol DISC 8022A (9/93) Yellow: GENERATOR RET.
<br />EPA 870 EPA 8700-22
<br />DO NOT WRITE BELOW THIS LINE.
<br />DTSC. Hol DISC 8022A (9/93) Yellow: GENERATOR RET.
<br />EPA 870 EPA 8700-22
<br />
|