Laserfiche WebLink
Star of Califomia-/eafth and Welfare Agency <br /> Fr - roved OMB No.2050--0039(Expires 9-Y Tox department ofces HealthContrServices <br /> -.t or type. (Form designed for use on 42-pitch typewriter). Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's U3 EPA ID No. Marshall 2. Page 1 Information in the shaded arses <br /> WASTE MANIFEST TU 06 49 <br /> 8 q) gf is not required by Federal law. <br /> 3. Genersto me aaY M n A dreg I <br /> A. State Man a o u n N ba�( <br /> A,ol r,4 Ili Petit 674 ln 4ac/recq cA ` 3 � 11 <br /> 1 B. State Generator's ID <br /> 4. Generator's Phone(?O4) z 3 9 • w of y y t x U��y y O �t. to <br /> 5. hwsp�ortCompany 4 Nam!J7 l C N L C uR04008 >9 � O � y, z y 3� D. TransporteTrar e7 <br /> rter <br /> Ur1 'ILC. State phone'siD <br /> N /� <br /> ]. Transporter 2 Company Name 8. US EPA ID Number E. State Transponer's ID <br /> F. Trenaporter'e Phone <br /> 9. Dqqionated Facility N e and Site.Address .,iJ 10. US EPA ID Number G. Siete Facility's ID <br /> .J KOe3.1rc. h(Jy„c)4c ( 0 { r clf +�0oy N5Z4. 57 <br /> /1A l L�' /�y�o/ H. F ilitY'a P one j <br /> (/ J D 0 9 y "z �115 3z y- /Y38 <br /> 12. Containers 13. Total 14. {. <br /> IP 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and W Number) Quantity Unit Waste No, <br /> zi No. Type Wt/Vol <br /> u CUlq5 /e U f1CV0 ✓w / sta. �/l <br /> E to GGJ EPA/ <br /> +�N N b. ;.Cl e - < Rn+n'/R7 e Lira U)1/ W a sf6. e <br /> ati 43 <br /> N F� A [ LC % UN lC/�j -o r QJ 3 111, <br /> R C. rc�ri7!/�oRl <br /> State.- 7/N/ <br /> A14 q r 19 "Nft/1J'fj 4F U z D D () / EPA/.Others S. - <br /> .F tl. Ar,17-,1XVov5 • Stata <br /> OKJaI— E /VA Q16CI 1011 0 S EPS /r—u7 <br /> 1y <br /> Z 114tldit?n to�� tip for rigli.L.ielad AbgyaL.� _-„- K. Hancling CodesLL11or Wastes Listed Above <br /> d )) d /17 /xc FCAI�f'LJhR(IbJJ[r Afe vii �ncF )t a1J232� a0� —Y'� b 01 <br /> 141 pc Fw-f.1taA% (CeN BZv%C,i a /137f -. <br /> c/ a. <br /> = till]• f!$ % wAT[)( 1t wJgSr< Flgom. < ,G .( LOW <br /> 0 <br /> F 18. Spacial Handling instructifugs sad Addy'ynal In 2tion <br /> )4 ,se vw e-L rzorecTvt EG1v/j0*iv4,,7 <br /> J <br /> J <br /> U 18, <br /> J GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> al and are classified.pecked.marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable International and <br /> Nnational government regulations. <br /> Q. If 1 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 <br /> 0 to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which mknmlzes the <br /> present and future threat to human health and the environment:OR.it I am a small quantity generator,I have made a good faith.sort to minimize my waste <br /> 0 generation and select the beet waste management method that is available 10 me and Mat 1 can eHord. <br /> Z <br /> CW7 Printed`/Typed Kama ✓ Signature ��,,�/� � ./ :' - A/onth Day Ysu <br /> w W ILI-Ii i �, - )*i � ;(,�.'L.l fAst�t /� -��-c_L y v 0 <br /> WT17. Transporter 1 Acknowiedgenmd of Receipt of Materiels _�__ <br /> Q R A PdMarta� I Sign Mpnffy par. <br /> N ©LmT r/ <br /> O S <br /> P <br /> W O 18. Transporter 2 Acknowledgement of Receipt of Materials All <br /> OT Printed/Typed Name Signature Abele-. Day Yw <br /> E <br /> Z <br /> 19, Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification e t of hazardous materials coveTd py this m cePt ea noted in Item 19. <br /> T _... .__. . . - _... <br /> i y PriM`J i b _..MoatlL— Y_ <br /> _ r <br /> DHS 8022 A(1188) <br /> EPA 8700-22 JUN Ae Below This Line(Rp 1 { <br /> Rev. Financia.editions are obsolete. rNVlr{ON MEIJI <br /> HEAT 7N Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> PERMIT/SERVICES <br />