|
Aug 28 06 11:23a Julie Huber . 268-3880 p,17
<br /> $rob d Califarda—Ewironmenrol Protection Agent,
<br /> Form A,aproeed OMB No.2050.00391Ezpirw 9.30-99! See Instruction$ on bock 090 b. Depmlmenld Toxic Substances Conn
<br /> heard ptiat ase type. form desigrsed kr esa o+stab f IZOA)typewrite,. Sacroormao,California
<br /> UNIFORM HAZARDOUS T Gersera'.!s US EPA ID No. M.m;led Docomnl No. 2. page 1 k nroNon -he shaded meas
<br /> is n,requbed by Fadwal lay.
<br /> WASTE MANIFEST ! 7 5 of 1
<br /> 3. Gvnerolofs Name and Mailing Address A Stare Mor4wt Dmwnnl Numb, 2 4 715 j 5
<br /> art,£F.!C.4N VALLEY !,,^.STL' ^II- !NC
<br /> G �i.v Dvri 's•1 ry B. Slab Gnervloi s ID
<br /> shit A Generators Fham 1 60U] !3"GJGHI) U1'-LFi!, UA 9.7137 ti
<br /> n
<br /> N 5. Transporter 1 Company Noma 6. US EPA ID Number C. Se•e Tronsporle/d FD IResarsed.l
<br /> h
<br /> m
<br /> r�•r r s s ry sn c-„ � r+ • � ^ t 'y D. imwpadels Pmne .c�sw
<br /> o s� ,1cr,N vAr.,_-, err.., �;!_ ., ., L v � :: - -•��
<br /> 0
<br /> m 7. Tromponw 2 Company Nom. R. VS EPA ID Numbs- E. S•oN Tramporr.rs ID
<br /> co
<br /> r–' F. Tram parlor's Phase -
<br /> <
<br /> V V 9. Designated Facility Noma and Site Address 10. US EPA ID Number G. State Fxilily9 to r/
<br /> '11iQ KIVtfiHANK UIL [RANf11•hK
<br /> rHzRX30 CLAUti ROAD T FadB Sts Plsene
<br /> r-O
<br /> CA 55,3137 Gi n.. Al . 01 Cl 0 9 20L$G3-8.13.1
<br /> �Q I1. US DOT Description findudi.9 Proper Shipping Name,Nazard Class,and ID Nu.mb,l 12. Conrainen 13. Total lA. Unit
<br /> "IV No. I T a Omnliy Wt/Vol I. Was[*Numb,
<br /> Z a Stole
<br /> = NON-RCRA HA7AROOLIS WASTF LIQUID 221
<br /> 1�En nit 1 0T T !'- EPA/OrFar
<br /> 3 � r
<br /> o N
<br /> m E EPA/Ones'
<br /> v R
<br /> v A State
<br /> o T
<br /> m O EPA/Olher
<br /> R
<br /> w d. Stale
<br /> w EPA/CRhw
<br /> V
<br /> W '. •I
<br /> J.Additional Descriptions for Maswials listed Above. K. HOnAing Cases for Wastes Above
<br /> O tided
<br /> USED OIL.&WATER b
<br /> ,� U1 '
<br /> a
<br /> y
<br /> W
<br /> m
<br /> C. d
<br /> Q
<br /> Z 15. Spocial Handling In,",fiansand Additicnel Inermfien
<br /> 0
<br /> a
<br /> Z GLOVES
<br /> I W EMERGENCY PHONE 2(39-ia17-885 i '
<br /> x
<br /> 16. GENERATOR'S CERTIFICATION: I bweby dedam that the mnlents of this crosiggnmentOro fully and Ocmraladescribed ahweby prvpenhippiag name and Oredassified.poc6c,
<br /> Vmarked,and ebeled,and an in all ro,,,,in prop,candifim er Imaspmt by highway cuordirog w appTimble inl,nalionol one natia+O gwernmenr regutatiov.
<br /> I d II I am a Jorge gwnfiy gen,aror,I e.Mt short hon a prop..is place ed,mdum the mlume and bsdciy d waste generated m IM degree 1:ww delesmined ro be emnomimlb
<br /> S pracneoble and Ibm: ve rolecled the Predicable,method of trealmanq storage or d,posal currently om;lahla to me which minimixw In.presets Ord fuWm th-.W m Auman healtF
<br /> ' and the m,iranm.m;OR,iF I am a s.oil q.,11ym
<br /> geraror,16.made o goad faith effort to minimize net,wash generation and sled-he best wc,m mse..,gment method that is
<br /> O ,Oil.bl.to m and that I ran o4ord.
<br /> V Preted/Td . //J .r 1 f SignaNre / / %Doth Day,
<br /> y • , Year.
<br /> / / / '0
<br /> i 1
<br /> Transports, Ackis.1sa +sent al Recei rof Mdbdab �•-��
<br /> I wam / C Signature -__ ` ..,Dy –
<br /> !m
<br /> rnanew j
<br /> d
<br /> P
<br /> 0 I S?Trerlksportcwr 2 Agkrmiodgomrl of it",,of Materials Manch Day ,Year
<br /> O i Prin,edRyped Name Signature
<br /> w E
<br /> R
<br /> V19. Discrepancy lndicafi nSpace '
<br /> Z F
<br /> A
<br /> C
<br /> 1
<br /> L
<br /> 1 20. Facilift Owner or Chrater C.1hik.110n of remit of hem,dosn oalmials aavered by Yrls manilas..c t as noted in Item 19.
<br /> Month 0 Year
<br /> T Printed/Typad. � Signal" J Day
<br /> DO NOT WRITE BELOW THIS LINE.
<br /> DTSC BC22A 11/99?
<br /> y EPA 9ICO-22
<br />
|