Laserfiche WebLink
12 <br />LL <br />t - <br />LL <br />LL <br />C. <br />tx <br />tf, <br />Z <br />C <br />tf <br />.W <br />Q <br />Z <br />C <br />a <br />Z <br />w <br />r <br />r <br />a <br />U <br />J <br />a <br />to <br />tY <br />O <br />V <br />Uj <br />W <br />9Z <br />U.1 <br />W <br />LL. <br />O <br />W <br />t!1 <br />a <br />U <br />ii <br />i1 <br />Stc-e of Califolmia--Environmemal Protection Agency f <br />Form Apprr•,ed OMB No. 2050-0039 (Expires 9-30-96) <br />Please Prim v type. Form designed for use on eiim (12 -pitch) typewriter. <br />See Instruc ions on back o., age 66. <br />Department of Toxic Substances Con <br />Socrome ,to, California <br />DO NOT WRITE BELOW THIS LINE. <br />..--c :c _. ... <br />DTSC 8022A (1/95) '_o� ,LOfi l:.: c:.n•.::�rc _.� .. - <br />EPA 8700-22 !+ <br />I�UNIFORM <br />1. Generator's US EPA ID No. <br />Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />HAZARDOUS <br />1111� <br />� WASTE MANIFEST <br />1 <br />t) 111 � <br />L <br />of <br />is not required by Federal law. <br />3.�/SrGeneraro Na[�Te cld jM,ayCling Address <br />Z�C;r e� � <br />A Slate Mamf�it D, acvtnetiR�Piumber 9 ' W -c �it� <br />p� <br />!!tvl <br />f <br />p rr) <br />/j1�,7{� <br />3 <br />11 <br />A. Generator's Phone <br />+ <br />, <br />1 <br />5. Transporter 1 Company Name 6, US EPA ID Number <br />4`C" ta'lef " ns= <br />'� S 1 <br />7/ _ <br />q1612 <br />D€irQtts�oiesKl'ItortesA <br />'4'�ali? <br />i C/ <br />rWt' <br />7. Trans tier 2 Company Name $. US EPA ID Number <br />3E Stat4'Tr rte�b ,y„r-zrr^?y�;M"''';�', <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />j <br />�• nr_ <br />HIS; <br />+14,if <br />= <br />�"F`'.T� <br />US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. ContonersU.Total14. <br />Unit11. <br />No. <br />Twt/volLl <br />..'- <br />EI <br />G <br />IN <br />R <br />" <br />4 <br />R <br />a <br />_ <br />I} <br />P <br />II <br />aY � + .Y�: r.} ® 1��dY�.. c -`� <br />-�cr4�•. ..,� µ � <br />--�"'-�.�3.,r _ 3•'s5 <br />W.:- �- _ "�: <br />15. Special Handling Instructions and Additional Information <br />Su � <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are <br />Fully and accurately described above by proper shipping name and are classified, <br />packed, marked, and labeled, and are in all respects in proper fondition for transport by highway <br />according to applicable international and national government regulations. <br />I! <br />If I am a large quantity generator, I certify that I have a program in place to reduce the <br />volume and toxicity of waste generated to the degree I have determined to be <br />economically practicable and that I have selected the practicable method of treatment, storage, <br />or disposal currently available to me which minimizes the presentand Future <br />threat to human b00% and the environment; OR, if I am a'small quantity generator, 1 ha <br />a made a good faith effort to minimize my waste generaselect the and selethe best <br />I management method that is available to me and that I can afford. <br />Printed/Typed Name' Sig re % <br />l <br />Month Day, - <br />C. --v ' r <br />L <br />21 12k <br />1 <br />R <br />17. transporter 1 Acknowledgement -a3 Receipt of Matenols <br />A <br />tt <br />Printed/Typed N c <br />f� <br />Signatur <br />Month Day pear2 l <br />/� <br />P <br />��� <br />(� 12j <br />a <br />19' - Trans cAer 2 A:knowied ement o ei t of Materials <br />R <br />T <br />Printed/Typed Name <br />Si ature <br />Month Day Year <br />a <br />11 <br />F <br />19. Discrepancy indication Space <br />,; <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator CerWication of receipt of hazardous materials covered by this m <br />nifest except as noted in Item 19, <br />T <br />Y <br />Printed/Typod Name Signature <br />4j 547v <br />57g <br />Month Day Year <br />q <br />P, UD <br />16 <br />12,147 67 <br />DO NOT WRITE BELOW THIS LINE. <br />..--c :c _. ... <br />DTSC 8022A (1/95) '_o� ,LOfi l:.: c:.n•.::�rc _.� .. - <br />EPA 8700-22 !+ <br />