Laserfiche WebLink
Slate of Cahforma—Envuanmental Protection Agency <br /> IFarm Approved OMB No 2050-0039(Expires 9 30 991 See Instructions on back of page 6 Department of Toxic Substances Control <br /> sePleapnnt or typs Form designed for use on able(I2 prkfsJ typewriter _ __ _ _ _ _ 1 _ __ _ _ ___ _ __Sacramento,California <br /> UNIF1 Generators US EPA ID No Manifest Document No I Page 1 Information in the shooed areas <br /> }QRM HAZARDOUS As not required by Federal low <br />' WASTE MANIFEST a <br /> 3 Generator s Name and Mailing Address .y0 <br /> U <br /> r <br /> f7 33 g, <br /> 4 Generators Phone{ <br /> 7 / S <br /> sS Transporter 1 Company Nome 6 US EPA 1D Number a e a <br /> � c r <br /> p <br /> 10 7 1 LE9 "A7 <br /> 00 ;4J} <br /> 7 Transporter 2 Company Name B US EPA ID Number a asarve ' <br /> Q uA� <br /> U 9 Designated Facility Name and Site Address 10 US EPA ID Number t p $1 <br /> Q I UZ>I f'IAL 's+L..I{VI1LE UfL C.U, Irl(- % <br />�^► � 700 "i S )TO -q7 <br /> 1 J O r N ♦/. r f>• 1/, Y ll 3 1'r T A <br /> 1 S '6II f -S <br /> Q1 L } 3 <br /> U 11 US DOT Description(including Proper Shipping Name,Hazard Class and ID Number) 12 Containers 13 Total 14 UnitNo Type Quantity Wt/Vol s um ter <br /> C <br /> RlON-RCItA HAZ Af�C 00%WASE 1,101'.310 / q x {, r <br /> E <br /> ' <br /> o N00 <br /> b d <br /> 00 F <br /> CN R <br /> e A c <br /> 0o T <br /> co O <br /> R <br /> Ce —LL <br /> LU cl <br /> Z <br /> LUU <br /> w <br /> a_ <br /> � I <br /> 115 <br /> trSpecml t{andling Insuctana and Additional Information <br /> f— ~ <br /> " a GLOVES <br /> �y <br /> LU EMI:.RcaIEENCY PHONE 204-667431[357rt 1] <br /> �" r'l��>�3y r r <br /> 2 <br /> H <br /> 1 16 GENERATORS CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper skipp;mg name and are classified pagked <br /> Vmarked and labeled,and are m all respects m proper conduion for transport by f;ighwapaccordmg to applicoble mternational and nahonal government regulations <br /> If i am a large quant%y generator,I certify that I have a program in place to reduce the volume and toxitsy of waste generated to the degree I have determined to be economically <br /> a procilcable and that I hove selected the practicable method of treatment storage,or disposal currently available to me which minimizes the present and future threat to liumon health <br /> and the environment OR if I am a small quantity generator, I hove made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> 0 available to me and that l can afford <br />' Printed/Typed Nome Signature r o Day ---Ye <br /> Z <br /> w l7 ons orter 1 Ackn.wI.Jgem.n1 of Receipt of Materials <br /> , 2 <br /> p Pnnted/Typ N�— <br /> Signatur o Doy �4 <br /> w H <br /> wS <br /> P IF <br /> B B Trans ocknowled en of Recei t of Materials <br /> O R Printed/Typed Name Signature Month Day Year <br /> T <br /> w E f� R <br /> V19 Discrepancy Indication Space , <br /> Z F <br /> A <br /> C <br /> f <br /> L ` <br /> I =Pnnted/Typed <br /> Operator Certification of receipt of hazardous matenols covered b this manifest exce t as noted in Item}q t <br /> r Signature Month DayYear <br /> 4*Y <br />' DO,NOT WRITE BELOW,THIS LINE. <br /> ttii : <br /> i�3` t <br /> DISC 8022A 11/99} <br /> EPA 8700-22 Yellow GENERATOR RETAINS [ ' <br /> t <br /> 1 <br /> r <br />