Laserfiche WebLink
Form Approved OMB No.2050-0039(Expires 9-30.94) See Instructions on bock os nage 6. <br /> Fleas"prim or type. Foran deigned far ut1 on Nile f 12 Fire' .writer. 9 Department of Toxic Substances Control <br /> Sacramento,Californio <br /> UNIFORM HAZARDOUS a abr's US EPA ID No. Manifest Dacu 2. page 1 Information in the shaded o sats <br /> WASTE MANIFEST ' //t 7�/Q n( /y is net required by Fedtfal hw. <br /> vV f I w Sv of <br /> 3. Generator's Name and Mail' g Address <br /> ITR W <br /> `I sci R Fc ONI��S RrE� 228 <br /> [� 6/ I ' �,�5' 2 Q p. Stay Gerierawr's ID <br /> 4 o s9 &' <br /> S. Transporter 1 Company Nome 6. U$EPA ID Number zrlwa�tso.ID 4ff t_/ <br /> C HEM I CA L WA srF MANAG Rw z I $Ph°n° ?09x,35, y .; <br /> <J7. Trarssponer 2 Company Noma <br /> R. US EPA ID Number Tc /s ID <br /> .� <br /> U <br /> Q Fmspatter's Phone , <br /> Z i noted F«ili Name and Site Add ss Facility's 10 <br /> I.n IC L, WAST1� MANAGEi `L'-ief `='"Tn,C <br /> � J .U, &-;K 471 3 S 2 S I U c D SItvL/&GF 'elhone <br /> o - O I C13al CIATO 0 916 11 1 7 ! J <br /> Cf' Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Comaainers 13. Taal 14. Unit <br /> No. T W Wt Vol LWaste Number.' '.r-' <br /> N � A'tzAl2DOUs WA Tr— SOLID1 C), 3, <br /> a Int 611�;� <br /> CD E (DOm�)(� Ir I ef}�p) G , NA3o77 bD N `f9S A/�d» <br /> N b. <br /> R <br /> A <br /> T <. <br /> aP O <br /> � R <br />' W <br /> Z d. <br /> W <br /> V <br /> ZQW <br /> 6 <br /> N <br /> W <br /> K <br /> ' J <br /> a <br /> (� 1IS., �vel Hamdpmg I ctiamms and Ad al Information <br /> i trf evZkaTte?1 <br /> VE C co"lti►N 6��a t o VEj G 066 LES <br /> C(fit 3 I iRZ G Env er r P -n, F kD2� x-( 14 —tel 3 U7� <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> a <br /> packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international tows. <br /> V <br /> If I am a large quantity generator, I certify that I have a program in place to reduce the volume 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 treatment,storage,or disposal currently available to me which minimizes the present and future <br /> S <br /> three to human health and the environerent;OR, H I am a mail <br /> quantity ganer(stor, I haw made o good faith effort to minimize my waste generation and select the bet <br /> waste mono meet methodMat is available to me and the I can afford. <br /> P' /Typed Nems M«y� <br /> 101-FOLS i ) (J -,1Z <br /> Z s 17. Transporter 1 Acknowled ement of Receipt of MaNrich <br /> NPrirdedd//Typed Name Si mw <br /> 171 la <br /> e <br /> O Trot r 2 Acknewled amenl of Recai t o Masrials <br /> T Printed/Typed Nam" Signature Month Day Year <br /> a <br /> N 19. Discrepancy IMitatien Space <br /> a F <br /> V A <br /> Z C <br /> I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Primed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS UNE. <br /> DISC W22A (7/92) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />