Laserfiche WebLink
May-21-01 07:57am From-D/K CUST-e"- +3105378386 T-896 P.02/03 F-949 <br /> Stole of Colilornia—Cnvironmentol Protection Agency See instructions on back of e b. <br /> Form Approved OMS No-2050-0039(Expires 9.30.99) page Deportment of To,sft Subuaecet Contra <br /> Please prim or type. Farm designed For we on elite(12-pitch)typewiror. Socromena,California <br /> 1. Generator's US EPA ID No. Manifest Document No, 2. fbge 1 I Infarmalion in the shaded areas <br /> UNIFORM HAZARDOUS is nor regaired by Federal law. <br /> WASTE MANIFEST Z I 1 1{ 5 Gi :Z G► S 4 S of I <br /> 3. GenetarolS Name or <br /> a�Jiin�g Address A. State manifest Document Number 20826845^ 6 8 4 5 <br /> �f0 �+ a <br /> pp 60 A 4;03 96-710-A B. State Generator's 10 <br /> 1SFA I <br /> I1 6. Generator t one I I M I v,S N O:)L <br /> t\ <br /> C-4 5. Transporter I Company Name 6. US EPA IO Number C. Sate ironsporle/s 10(Rnened.) <br /> H GG t <br /> o �(�5'i G-fti Vt r9�1 m'riN fz'e' GI k a 0 O O i/ 1 I u D. Tronsparter's Phone I f7J-71"1.9—(�7r� <br /> O 7 '{ <br /> 00 7. Tronsparler 2 Compan7 Nome B, US EPA ID Number E. Store Tronsponer's ID 1 as .) <br /> f. Trortsponer's Phone <br /> U 9. Designated foeilly Nome an Site Address 10. US EPA 10 Number G. Scare Facility's MO a /7elrwceno xa� oorl T 1 : 5 2 <br /> V )Loco Nu r rk JV"V-oda C-k'r �..o�l3S K. Faciby's Phone �10 <br /> O(� <br /> 0 &-- }vh CA q02�� �310�$�� <br /> V <br /> 11. US DOT Description f inclAing Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 1�• Unitl <br /> No. T Quantity Wt/VoI. Waste Number <br /> �l Z on - C Raz oVs Va4e ! Llll Id Stare <br /> 3V 3x <br /> 3 G D O 01571010101 C EPA/Other <br /> `� Slate <br /> N b. TNIS WASTE STREAM HAS BEEN QUALIFIED <br /> 4 R FOR 4�EC`(C!fl 1 f�EATMENT AT THE EPA/Other <br /> C14 A c U _i• t State <br /> co co o CALIFORNIA.!IiS FACILITY HAS THE MECESSARY EPA/other <br /> RPERMITS TO RECEIVE YOUR WASTE STREAM AS <br /> W d QUALIFIED. OUR EPA PLUMBER IS CATO S'°" <br /> W EPA/Other <br /> V <br /> W <br /> � J. Additional Oesafptfons for Matrriols listed Above K. Fondling Codes for Wastes Listed Above <br /> Z p <br /> C) t/ <br /> V1 <br /> W <br /> a <br /> Z p 15. Special Handling Instructions and Additional Information �Jesr PCo�el � f�q <br /> W��h iwv► fs J <br /> R14 It, e <br /> W yyy 4- <br /> P- o if S 1 <br /> Le- <br /> 16. GENERATOR'S CERTI1F1CATION: I hereby declare that the contenA of this Consignment ore fully and occuratal described also+e by proper shipping name and are dani6ed,pocked, <br /> Umarked,and labeled,and are in all respects in proper condition for transpor?by highway according to applicable international and national gamrnment regulations. <br /> If I am a large quantity generator,I Certify shat I have a preggrom in phaco to reduce Ili.-plume and toaiciyy of waste generated to the degree I hen determined to Ise economicallyr <br /> o -. <br /> trordtaposd evrrently available b cite which mimmtzes the present and fururo threat to human heaid <br /> Practicable and that I have selected the practicable method of treatment,abt <br /> and the environment;OR,if I em a small quantity generator,1 hove made aid folth ato minimize my waste generation and select the best waste mataganronr method rhar:s <br /> o� asralkble a me and that I can afford. <br /> OPrinted ed Nome _ A n w Signa Month Dar Q a' <br /> Z N11 F1�1 to <br /> W <br /> 41-142— <br /> (� T, 1 T, Transporter 1 Acknwlad emanl of Receiptof materials <br /> 1W Printed/mad Nome Signolur r Month Day Yea <br /> W s 2 0 <br /> set. 0 18. Tran rear 2 Acknowledgement of Recei r of Materials <br /> 0 R Rinsed/Typed Nome Signature Month Day yea <br /> T <br /> Z F 19.Uj <br /> 61- y dISCrepancy greater an �variaj i n reconcl e <br /> - A with ge ratoNt nspo Ver on with <br /> of �s. Received — 3 gallons <br /> l <br /> I 20. Facili Owner or Operator C.rrl ieatiao o neat t of hazardous materials mvered 67 this moaifeu ii-OW as reared.n Item 19. <br /> T Printed/Typed Nome SlgnormisMonth Day ye, <br /> DO NOT WRITE BELO IS LINE. <br /> DISC 8022A(1/99) <br /> while: TSDF SENDS T}u � <br /> $ COPY TO 'SZ <br /> - <br /> .o. P.O. Box 3000. Soc'omenro <br /> EPA 8700-22 <br />