Laserfiche WebLink
State of CddO n��.�prt "':i1 .r //��Fz�qq pp//) ]7g C <br /> Form Appr.Mb^0�( zpires - - 9 z $!' 591t O"CT1D05-0 �QCI( age b. Deportment of Toxic Substances Control <br /> Pleaze print orlype. Form designed kr use on elite(12 pilsseepewriMe 881171 Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFgRM'HAZARDOUS is not required by Federal law <br /> WASTE MANIFEST A 11, 10 10 10 1 3 5 9 3 5 3 4 0 '' of 1 <br /> 3. Generator'.Name and Mailing Address A. State Manifest Document Number` 7 . e1 8772 <br /> Cum,cm ►4.T)kL FINISHING <br /> 0 3400 SO HWY 99 B. State Generator's ID <br /> n is 4. Gerrumm Pho..ST NICiN CA 95215 (209)463-5811 LL-f���_ <br /> N 5. Transporter 1 Company Name d. US EPA ID Number C. State Tmnsportnr's ID <br /> h <br /> rA D. Transporter's Phone <br /> 0 <br /> 21 st century MI 1 e. H'l.l L'tr,w; <br /> a? 7. Transporter 2 Company Name 8. US EPA ID Number E. Stam Transporter's ID <br /> E Transporter s Phone <br /> vU 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Stare F.Oiry's ID <br /> HIMILING1IMi FAVIIAM>l*]ITALr INC. KEWI' <br /> "'Z H F li .Phone <br /> _� '10245 'T'FM AVMW, SUUrl41 ty'. <br /> KEW,*- <br /> 12. Conminers 13. Total 74. Unit <br /> _,U L17. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. T pe Quantity Wt/Vol 1. Waste Number <br /> l <br /> jZ a Sok <br /> ? NRELE dtcAluTD�EHUEne 6.1 ON1593 MII (11) 916100 <br /> G 1+0 11 1 F G erl iT <br /> E <br /> o N b. <br /> co E <br /> a R <br /> v A a <br /> o T <br /> 0 O e <br /> R <br /> w d. <br /> wZ <br /> her <br /> U <br /> LLL- <br /> J. Additional Desuip'ionz for Materials Listed Ahove K. H-ndllnp Codes fc:wastes Listed Above <br /> Oi! jllk-64- 1 Gine FBet - CP 311'RINPER RW6 ' !K14 ,I ' <br /> N <br /> W .. <br /> Z 15. Special Handling Instils m and Add tmnal Information <br /> O <br /> 172-7159 ete'e'........ (WIPICATI OF DISPOSAL REQU&YZ <br /> M <br /> W <br /> S <br /> 16. GENERATOR'S CERTIFICATION: Ihereby d1leplare that the contents of this consig ent are Fully and accurately described obove by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respeclS in proper condition for transport by highway according to applicable international and notional government regulations. <br /> J If I am a large quantity generator,I certify that I have a preggrom in place N reduce the volume and toxicity of waste generated to the degree I have determined to be economicaIty <br /> a practicable and that I rave selected the practicable method al treatment,storage,or disposal currently available to me which minimizes the present and future threat to human h.'= <br /> and the environment;OR,if I am a ..If quantity generates,I have made o good kith effort N minimize my wastes genearim and select the best waste management method that is <br /> 0, available to me and that I can afford. <br /> O <br /> Printed/T NameSigsmNre Month Day Year <br /> Z i <br /> w T 17. rainsporuer 1 Acknov ed a em of Racei t Materiab ` <br /> � R , <br /> W Printed/Typed Name SignetureMonth Day Year <br /> w : 7 <br /> 18. bans o cknowled o ant o!Racei t of aterials <br /> Printed/Typed Nanta SignaNre Month Day year <br /> w E <br /> Q <br /> V E 19. Discrepancy Indication Space <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of recti t of hazardous materials covered by this manifest mo:e t as noted in Item 19. <br /> T Primrso/Typed Nome Signsums Manlb Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE.' <br /> DTSC 0022A(4/97) <br /> EPA 8700—,22 Yellow: GENERATOR RETAINS <br />