Laserfiche WebLink
1 <br /> State of CalJornio—Environmental Protection Agency 1 <br /> or Approved OMB No 2050-0039(Expires 9 30 99) See Instructions on back of page 6 Department of Toxic Substonces Control <br /> lease print or type Form designed for use on elle 112 pitch)typewriter Sacramento California <br /> Z Generator s US EPA ID No Manifest Document No 2 Page t Information in the shaded areas <br /> UNIFORM HAZARDOUS g I <br /> WASTE MANIFEST /l !, /� / r of [ snot required by Federal law <br /> " <br /> 3 Generator s Nome and Mailing AddressM : <br /> 9 / A lStale'hlonifasf Document Num6o�' <br /> i4boqTw <br /> o <br /> ao��n X1 t" �rt x'ws r,1, .��Y�� r <br /> 4 Generator's Phone 1 / 'U \J 1 U �..,s.� f ��C.�� r�>'�'d�'� 'fin �^ figs F. `l b;+x "4 , <br /> s-,r ter, p. eq gfx,r a�'� '�se <br /> 5 Transporter 1 Company Name 6 US EPA ID Number C'"Stafe Transporter 0ID fRaierved 41 {S �" Ii <br /> 11 <br /> ,ai�lE�-aIGAN V,A?`I_I``r ��� -a"a .+�„'r e �r� ��wy�� .n �� <br /> O I: Qil. A L 0 0 Q 8 2 7 7 i:D rD rTtonaporter s Phone;,t}s, l�ji,}� sty ?v� } <br /> 7 Transporter 2 Company Nome N <br /> P P Y 8 US EPA ID Number �ESlateTianaporl��,IPy[ReservedJ'� <br /> 11 "Tramlporrar <br /> V 1jtVVgV1cXfgRyb1r e 9nI09WATR 10 US EPA ID Number G itstotfa i fIDhna <br /> 5,W0 CLAUS ROAD r ,n "j",1-J" 11 1�Q 1 l t-' r, , V I <br /> RIVERBANK CA <br /> FaCeh 1511hone 4 ! »u <br /> A ')53 7 A I L 0 0 €) 1 9 08 '!96:3'6� 3 gq ', '; ', <br /> ! c r. 'i- 'f!'n yk`i`- <br /> 12 Containers 13 Total 14 UnitfL+� t i sr 3 <br /> r <br /> 11 US DOT Description(including Proper Shipping Name Hazard Class,and ID Number) " -'e a Gq <br /> No T a Quantity WI/Vol I vv rife Number + <br /> State <br /> NON RCRAWASTE i r <br /> i--lAZ AF�i�OL) , L.I[ llIE3 x <br /> 2Tf-. fl <br /> ( C)iLYIfiTl !7 } i} i [ 7 r-, <br /> E (j EPA``/Othei' <br /> r^ <br /> `r <br /> b <br /> v R EPA/0th�rf=J� <br />' T <br /> 0 '1,v �n4 <br /> (Z .EPA/Ot)7er,°r-"')) "j PA k, <br /> d <br /> i <br /> ss t EPA/Oth»e�.'e <br /> 'JI Add forte]Desch tions for Materia ti fed Aba e z a t e l <br /> 7 P Yi Ha din Caries for"Wast"s ,s'- <br /> c y''SstS-! ,.��l,ry y�C.+� ( p� ,' tq! a Listed Abave}rr.-e <br /> IL7 W,f .9 Let{ Iry ✓ ¢w'" �� r^rq',4 T'W`" r.� 'ayh ' -;.k w" M rr 1 `if � ,Vr�f'Y{rn+' l ef3 Kr r t"y�'�1A r r ". �,F�yti 1 -y <br /> � ✓,� <br /> t r <br /> 4.tpe ae74ti �. 1:,r s�r Ja ��' ,x y � sr;•',��P �� r '!w! p,rS r1 s .vY �''?w 'ia '�� �,f-'�t'c��i�""x.x� 'q`� � `s A. <br /> 15 Special Handling Instructions and Additional Information <br /> Cil OVES <br /> Z EMERGENCY PHONE 209-667—MS7 j <br /> 16 GENERATOR'S CERTIFICATION I hereby declare that the contents of ihu const8nmant are fully and accurately described above by proper shipping home and ore classified packed <br /> Vmarked 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 quontity 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 /> and the environment OR if I am a small quantity generator I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> O <br /> available to me and that I can afford <br /> Printed/Typed Name a Signature. ; Month Day year <br /> T 17 Transporter 1 Acknowledgement,of Race t of Materials <br /> R <br /> wPrinted/Type M6me Signature M h ay Year <br />'` P4 (/ 1 <br /> g 18 Frans orTer 2 Acknowledgement of Receipt of Materials <br /> T Pnnfed/Typed Name Signature Month Day Year <br /> W <br /> R <br /> F 19 Discrepancy Indication Space <br /> A <br /> C i <br /> 1 <br /> 20 facilityOwner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in item 19 <br /> Printed/Typed Name Signature Month Day Year <br /> I <br />' DO NOT WRITE�BELOW THIS LINE } <br /> i <br /> DTSC 8022A (1/99) <br />�A 8700-22 Yellow GENERATOR RETAINS 1 <br />