Laserfiche WebLink
'joie if C?-olifornia—Environmental Protection Agency <br /> rm approved OMB No.2050-0039(Expires 9-30.99) See Instructions on back of6, �. <br /> ease.print or type. Form designed for use on elite(12-pitch)ty ;r. ] Department of Toxic Substances Control <br /> Sacramento,California <br /> UNIFORM HAZARDOUS 1 Generator's US EPA ID No. Manifest Document No Page 1 Information in the shaded oreas <br /> WASTE MANIFEST k L u tt 0 j: t not required by Federal la, p <br /> of <br /> 3. Generator's Name and Mailing Address At5tate anifest Document Number <br /> F S STIDIC H Mr. NAINTEAA10E 7 A 369 ( L. <br /> 313! ;&'„1I <br /> All <br /> ROAD J'�t <br /> n! c1.�}iTill�, Cfl �IZry� �^ B. State <br /> Generator's ID <br /> �! 4. Generator's Phone ( w7 70J-6278 Coot.&C.t: PA RIT;K EQh <br /> 5. Transporter 1 Company Name 6. U$EPA ID Number <br /> �> C. State Transporter's ID[Reserved.] <br /> J I It+J7:}l, Fife}}I1>RRp TAL TMH. h �+ r D. Transporter's Phone 4t y}j1_4 I I V <br /> 7. Transporter 2 Company Name <br /> 8. US EPA ID Number E. State Transporter's ID(Reserved.) <br /> 1 <br /> `t F. Transporter's Phone <br /> 9. Designated Facility Nome and Site Address 10. US EPA ID Number G. State Facility's ID <br /> f�K i ErfTilLtlRE <br /> tltAL TECH C �' 51 i 6 <br /> l <br /> My 6t12 <br /> ty's Phone <br /> L'r f fit '1 i9.lYiI?G '163 <br /> .T <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number( 13. Total 14. Unit <br /> Quantity Wt/Vol I. Waste Number <br /> a."01111 "" IRIs V LIQUID State <br /> ti i Hl"..ENe !iITCM,1- -2-PYRROLIDONE} EPA/Other <br /> b.iii9li-R RA HAZAHDOUS MASIE,.SOLID - <br /> )f:��:I:; r�nrRTAIIINATED MI .,ISOPROPAN01 istare <br /> EPA/Other _. <br /> tilli(L <br /> �1 State <br /> f; <br /> #K. <br /> EPA/Other <br /> State <br /> EPA/Other <br /> 1. Additional Descriptions for Materials Listed Aboveandling Codes for Wastes Listed Above <br /> b. <br /> C. d ' <br /> s � <br /> 15. Special Handling Instructions and Additional Information s <br /> 7"1 7- <br /> 16, <br /> — <br /> i <br /> i <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are clossified,pocked, <br /> marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable 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 determined to be economically <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> f and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize <br /> available to me and that I can affordmwas)u'generotion and select the best waste management method that is <br /> . y <br /> i <br /> y PrinO /Typed Name; A..f <br /> �sr..,,�f� Signature <br /> a ,,! r �i j y /J � _ .. Month, Day Year + <br /> ,j `� f...�.... <br /> 17. TrarYs orfi? .l Acknowledgement of Recei t of Materials <br /> Printed/TypedKralome -- - - <br /> 1 4 Signature ' ''( Month Day-` Year <br /> 18. Trans 6Frer 2 Acknowled ement of Recei t of Materials - <br /> Printed/Typed Nome Signature`"' <br /> Month Day Year <br /> 19. Discrepancy Indication Space <br /> 20._Facility Owner or Operator Certification of receipt of hazardous materials covered bX this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature <br /> Month Day Year <br /> --i:e�-•r,ee kuAbet'': 8 00@p644$2 <br /> DO NOT WRITE BELOW THIS (.INE. <br /> BC22A ]1/99] BI„r•. GENERATOR SFNi c $ <br /> 7CO-22 '- WITHIN 30 D + <br /> P.O. Bc a0 3o <br />