Laserfiche WebLink
Department ofHealthJerwLea <br /> d Toxic Substances Control Division <br /> Sorted Approved <br /> No, <br /> end Welfare Agency Sacramento,California <br /> Form Approvetl OMB No.2050-0039(Expires 9.30-P� � • <br /> Plae as rint or t a. Form des, nod for me on el, - ilcn ewnler. 2. pee IEE <br /> 'UNIFORM HAZARDOUS Generator's US EPA ID No. Mamn�ilea 9he shaded areae <br /> D 9 90 /t � ofby Federal law. <br /> WASTE MANIFEST _ J A. State Mber <br /> 3. nerstor's Ne a and Mallinqq Addr�ea L� _ g 7 - 60195 <br /> G, frc ��r /CC 1//G <br /> IX/ /-(+/ owe 537G0 B. State Generator's0 <br /> 4. Generator's Phone( ,V 4) yy7 'SS67 / <br /> g, US EPA ID Number C. State Tranaporter's ID r///(r S,•�0//1`y <br /> 5. T naparter / Company Name - y <br /> �jn{moi yn iii r a.7 AT)+/i g <br /> c a 9 o �' i/ 0 3 D. Tranapo tar's Phone <br /> 7. Transporter 2 Company Name <br /> g. US EPA ID Number E. State Transporter's ID <br /> F. Traneponar's Phone <br /> 9, Designated Facd t Name and Site Address /0. US EPA ID Number D. St to F ciMy' ID <br /> �SS��,,/{ > fid.►/ '01 <br /> H.H. Facility's Phone <br /> Ra nGl�c (c. ✓.� r C 9fe7o 1 F, _/i jContainer$ 9/6 -S�f -000C <br /> 13. Total 14. I. <br /> Duemity Unit Waste No. <br /> 11. US DOT Description(Including Proper Shipping Name.Hazard Clava,end ID Number) e Wt/go <br /> State S� 2a �A7s/� /Ys/ w �i6r/ Cin/h.a. •,,,,rrxsr . v,�, JEja Q p EPA/01 eta fJ/ <br /> NUh/1v Stat. 3Y3 <br /> E b. (r.ft G'fJ rfr A7r ✓i-�f is'n i►7I/ r 'ryllr// <br /> A / Q O I D / EPA/0111erDO� <br /> l (f � o <br /> 0 State l7� <br /> a <br /> EPA/Other <br /> 6)01a h 3 0 RCR <br /> State <br /> a. <br /> EPA/Other <br /> K. Handling Codes for Wastes- ste Above <br /> J. Additional Descriptions for Materials Listed Above s I ,1 b. <br /> /_11 <br /> b . 9•f S//%-'-! 'r� /Mr.<f✓/f J <br /> C. � d. <br /> L_ a,/y r.f�f/ t</r/r1r+� C0AI/ 44.ro4ts./ <br /> 15. Special Handling Instructions and Additional Information - - <br /> �/S-r ��u�lc�i✓� clat�i,�-� .,�i„ LI.���/., 7 �o� � 7DD� <br /> GENERATOR'S CERTIFICATION: )hereby declare that the contents of this consignment are fully and accurately described above by proper shipping <br /> name and are classified, packed, marked,-and labeled, and are in all respects in proper condition for transport by highway according to applicable <br /> international and 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 <br /> determined to be economically practicable and that 1 have selected the practicable method of treatment, storage. or disposal currently available to <br /> me which minimizes the present and future threat to human health and the environment; OR, if I am a small quantity generator. I have made a good <br /> faith effort to minimize my waste generation and select the best waste management method that is available to me and that i can afford. <br /> Mo M Day Year <br /> Printed/Typed Name S _ �} I1 Z 91 <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials / / / <br /> S / '/ /� Sip store aY—ZYi/ C <br /> A Printed/Typed Name ( / r <br /> G v <br /> P 18. Transporter 2 Acknowledgement of Receipt of tedals \•:�U <br /> O !% ondl Year <br /> R Printed/Typed Name Signature = <br /> T n <br /> E <br /> y. <br /> 19. Discrepancy Indication Space <br /> F <br /> AFP <br /> C T <br /> i <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 /> Tran ure Month Day Yee�Xy <br /> Y <br /> Tp Typed Name 101 1I 1U <br /> L. <br /> DHS 8022 A(1/87) Yellow: TSDF SENDS THIS COPY T ENERATOR WITHIN 30 DAYS INSTRUCTIONS ON THE BACK <br /> EPA 8700-22 <br /> (Rev.9.88) Previous editions are obsolete. <br /> IN CASE OF AN EMERGENCY OR SPILL. CALL THE NATIONAL RESPONSE CENTER 1-800-424-8802; WITHIN CALIFORNIA CALL 1-800-852.7550 <br />