Laserfiche WebLink
aro of OalifomiaHealth and Welfare Agency Department of Health Services <br /> amm Loved OMB No.2050-0039(Expires 9-( '1 Toxic Substances Control Division <br /> f'1 a Qnrh or type. (Form designed for use on i_ f2-oltCh typewriter). Sacramento,California <br /> UNIFORM HAZARDOUS t. Generator's US EPA 10 No. Manifest 2. Paget nfor-ation in the shaded areas <br /> WASTE MANIFEST q T O 2-4 Docs O N 1 of Snot required by Federal law. <br /> 3. Generator's Name and Mailing Address A. State Manite doyument_Nurpbgt <br /> =/vdX % 1 f� ,or"1I 8838147 <br /> Ale,--o s&d v!,ra,a c t%at Dr7 <br /> M-4 A.Tat A t N S S 63 G B. Stela Generator's ID <br /> 4. Generator's Phone(� — 6 L ei , 4 j/ G �e U L / ,7,e <br /> n 5. Transporter 1 Company Name 9. US EPA ID Number C. State Transponer's ID <br /> D. Transporter's Phone <br /> Row►ic c c A L— A D o o G ' 1 p tii3_34 -/fc <br /> m 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> F. Transporter's Phone <br /> 9, Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> RomGLc cw he.rr)cwc cc/ire C O 9 (D <br /> Na 2 `, O l 1J A% /I VA/� N3L J H. FeciktY a Phone <br /> Z EAS Aqi D R' lv -4 V U`1 119 7 7 �!/5-) 1Jesse 4- /4 <br /> 2 12. Containers 13. Total 14. I. <br /> 0 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> No. Type Wt/vol <br /> cc a. Hj7 A rEJ4s EVH$�p �tJLYlI /blLiS• State 3l-2 <br /> Y r E L1 TT/ C A//9 C/T�y o 1 U / EPA/Othei <br /> Clo.- R b y^�,+. a g�A,,,y} 4 2 State /� <br /> w m T ■ ■ `kms '! <br /> fp 1 <br /> A b EPA/Other <br /> N 0 <br /> e R c. JUState NZ3 1992 <br /> zoa7y ENVIRONMENTAL HEALTk EPA/Other . <br /> 1¢0 d. PERM If State <br /> Z <br /> U <br /> EPA/Oche <br /> W <br /> Z J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> I/ � GotvTgntar�tTc/1 /4�b.vtjLnit.�i A7g7'ea.,f4 a. b. <br /> N ,t. y 9 <br /> Jq it. <br /> Z r <br /> 0 <br /> F 15. Special Handling Instructions and Additional Information i <br /> Z G{/PAA /g00'/ADel? /.vTc j� RSoNA� /��tcreciiLle r uij�nlFsJ <br /> J <br /> / /Pt-00, <br /> J <br /> V tee <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 /> s� and are classified.packed,marked,and labeled.and are in all respects in proper condition for transport by highway according to applicable international and <br /> ���4111 national government regulations. <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 <br /> to be economically practicable and that have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> Y p seen and future threat to human health and the environment,OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste <br /> O generation and select the Deet waste management method that is available to ma and that I can afford. <br /> w Printed/Typed Name Signature B Month Day Year <br /> X <br /> w R 17. Transporter 1 Acon"Iedgematd of Receipt of Materials <br /> < N Printed/Typed Name �`// Signe Month Day Year <br /> o B Ao 71a�Y�f ✓ ¢ �- - . <br /> P 1& Transporter 2 Acknowledgemem of Receipt of Materials <br /> W O <br /> TPrinted/Typed Name Signature Month Day Year <br /> E <br /> Z <br /> 19. Discrepancy Indication Spam <br /> F <br /> A <br /> C <br /> 1 <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T <br /> y PrMtatl/Epo ams Signature / MonthDaY Year <br /> T / f <br /> I <br /> DHS 8022 A(1 l89) Do Not Write' low This Line <br /> IPA 8700-22 <br /> Rev.9-88)Previous editions are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />