Laserfiche WebLink
I'd-u: .,enrvin+e--i ealul ane 5^reliare N-Jency0 Department of Health Services <br /> Fc-nnApprovedOMB No.2050-0039(Expires 9-30-9 Toxic Substances Control Division <br /> Please print or type_ (Form designed for use on elife itch typewriter). Sacramento,California <br /> ` -ONIFORM HAZARDOUS ]1. nerator's US EPA ID No. Manifest 2. Page 1 <br /> Information in the shaded areas <br /> WASTE MANIFESTD== ant N <br /> of is not required by Federal law. <br /> 3- Generator's Name and Mailing Address +.-rte. A. Slate Manifest Document Number <br /> RAPIDS ENV]R011!,''-?2TAI S-ulr;- 1 1 L �n � / �, /�— <br /> P.O. BOX Ent _ ,r:5 Su(ifH RIl'1 R RU. C� Va "'t <br /> 1lt5i $i4tTL1h9EPlTO, C,iIIFONLA 5:5 1 e. S to Generator's to <br /> /// �l //� t. <br /> 4. Generator"a Phone( �]�� 321-25,10" - - <br /> 5. rensporter 1 Company Name 6. US EPA ID Number C}Slate Transporter's D <br /> N r - D- Transporter's Phone <br /> 'n74. Transporter fnpany Name - S. US EPA ID Number E. State Transporler's t <br /> m <br /> O 1 1 1 1 1 1 1 F. Transporters Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. to Facility's ID <br /> RMIOS E'VVIFOiifdEll7.r.'_S =snr-r <br /> P.Q Bax in, _ 'Se5 Svllfil Rll:Tli RC. <br /> H. Facility's of <br /> I sriSi SALRA REW0, CALIFO'7?41A 95631 <br /> PIC)3]]-"c57t - f � / (� <br />—t 12. Containers 13. Total 14. I, <br />,�� 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waite No. <br /> a No. Type wiJ <br /> a' State <br /> r. G <br /> E j t r �'] EP !Other <br /> E b. — <br /> State <br /> N q ' <br /> O <br /> m A <br /> m T EPA/Crther <br /> c O <br /> N <br /> C R C. <br /> State <br /> o <br /> Q <br /> oa <br /> ' EPA/Other <br /> U.1 d. State <br /> Z <br /> w <br /> CJ <br /> EPA/Other <br /> w r <br /> N J. Additional Descriptions for Materiels Listed Above K. Handling Godes for Wastes Listed Above <br /> CL <br /> CIO ` <br /> 15 <br /> A �1 L <br /> r <br /> O <br /> 15, Special Handling Instructions and Additional Information <br /> 4 <br /> Z <br /> ut <br /> x. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classilied.pecked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable intemetional and <br /> CL national government regulations. <br /> fn <br /> 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 /> p to be economically practicable and that I have selected the practicable method of treatment,storage.or disposal currently available to me which minimizes the <br /> } present 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 /> U generation and select the best waste management method that is available to me and that I can afford. <br /> Z <br /> w PrinledtTyped NSignature Month Day Year <br /> C7 <br /> ¢ f <br /> W421 ..7 1 C ter „ <br /> WT I'll. Trahaporter fAcknolMedgernord of Receipt of Milerials / " - - <br /> R <br /> Z <br /> A Printed/Typed Name 1�- <br /> 0 <br /> nature <br /> 6 N f g ♦ Month Day 'Year <br /> o LL S /- r1 i�P 18. Trans orter 2 Aoknowle p gement of Recei [of Materia - <br /> UI <br /> -Q R Printed/Typed Name Signature 1. Month Day Year <br /> U E <br /> 2 <br /> 19. Discrepancy lndication Space <br /> F <br /> A <br /> C <br /> 1 <br /> L <br /> 1,- <br /> I 20. Facility Owner or Operator Cariilication of receipt of hazardous materials covered by this manifest except as noted in item 19. <br /> y Printed/Typed Name Signature Month flay Ysar <br /> Dlts 8172 A(1 r8e) Do Not Write Belaw Tis ane <br /> EPA 8700-22 <br /> (Rev.9.88)Previous editions are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />