Laserfiche WebLink
.e print or type. (Form daaV NW for use on eiife(12pitch typewriter). R" 14"Subslancas Control Division <br /> UNIFORM HAZARDOUS 1 Irator's US EPA ID No, Manifest loQo t Sacramento.Caiilorms <br /> Inlormatlon in the shaded areas <br /> WASTE MANIFEST ' 1 / Docu�ent�. o! is not required by Federal law. <br /> 3. Generator's a and Mailing Address A. Slab Manifest Doc of Number <br /> L-#f 13sj c �..y `cs'xf 899 023 <br /> / <br /> P. stab Getwatora ID <br /> 0 4. Generator's Phone}# �)t' r <�y '„_ ^ , 1 I <br /> 6. Transporter 1 Company Name <br /> 6. US EPA 1D Wumbee C. State Tranaponar'a ID I <br /> N ii I i i J r r 1'L AC 1A Ia I iiI 1.5 v 1 L1 17 !J Ii t u D. Transponere Phone J <br /> 7. Transporter 2 Compan1 U-4ziva <br /> y Hama 8. US EPA ID Number E. State Transporters iD <br /> 8 F, Tran&poners Phone, <br /> 9 <br /> P. Designated Facility Name and Site Address 10. US EPA ID Number Q Slate Facility's W <br /> u,:i�f+r:ra�s �::rvic� L' IA Ia 10[it 131116 <br /> 6 - 161112 <br /> a <br /> .J.i.;l tt 14" S4 ?4E LL:f:;,jn K FaciWy'&Phone <br /> ir IC IA-LJ 10 14 1 11 LuLu 17 1 z u <br /> 00 11. US DOT Description(Including Proper Shipping Name,Hsurd Claw,and lD Number) 12. Containers 13. Total 14. L <br /> ANo. TYPe Quantity' Unit Wavle No. <br /> V •, Wt/Vol <br /> State <br /> Z G ..r:5fr. FULL CJ0-,:WSTIf3LrE LlIQUID <br /> ~ E ,•.1J 1JJ.3 EPAiOther <br /> E b. T 1 <br /> 3 N S L (i <br /> o R <br /> m A State <br /> m T <br /> N O EPA/Other <br /> R C. <br /> g Slate <br /> m <br /> FPA/Other <br /> W d. <br />� Slab <br /> w <br /> U ' <br /> w <br /> EPAfOth r <br /> 2 J. Additional Descriptions for MModais Listed Above K. Handling Codes for Wastes Listed Above <br /> to <br /> �:. .:�►Ti:ix k.%j kIIIISA , a <br /> LU <br /> �N r ALL <br /> J <br /> Z 41 <br /> � , <br /> tb. Special handling lnsvugion&and Additbnel Information <br /> t <br /> AUG 2 2 <br /> �.:51•�,:r,Tcir r.�C1LiTY t•'+L.j�:�ntr�GY �QdiACT 0 ljOU0),U74-4;I�i4 r:, VIFRDE�1IMENTAL HLALTH <br /> L...\:...y t d{ �i'�Li(ui.\rY l.U'���a"►Z Tf{r r t i <br /> i..—• <br /> - � <br /> GENERATOR'S CERTIFICATION: I-hereby declare that the contents at this consignment are fully and accurately described above by proper shipping name <br /> and aro Classified,packed,marked,and labeled,and are In W reapecta in proper condition for trap <br /> d national government reguiations. •[rort by highway according to applicable international and <br /> W <br /> x It I am a large quantity generator.I comfy that 1 have a program in place to reduce the volume and toxicity at waste generated to the deg <br /> ree I have determined <br /> p Io be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimises the <br /> y present And future threat to human health and the environment;OR,if 1 am s small quantity generator,I have made a good faith effort to minimize my wast <br /> -generation and••lett the beat waste management method that la awdabfe to me and that I can afford. <br /> Printed/Typed Name r <br /> f f^�r'flure 1 1' F '" Month DAY Year <br /> uRT 17. Transporter 1r Acknowledgement of Receipt at Mat*"& !' / <br /> A Printed/ pe Name Signature <br /> N f i Month Day Year <br /> s ! '/ /; <br /> Ll O 1S. Transporter 2 Acknow , <br /> lodgement of R eipt of Materials <br /> T Printed/Typed Name Slgnatwe <br /> E A000111A000111Day Year <br /> tti. Discrepancy indication Space <br /> F <br /> A <br /> C <br /> t , <br /> 1[20. <br /> F&CiGty Owner or Operator Cenilicslion ofreceipt of hazardous materials Cod by this manifest except as noted in Item 19. <br /> rintodiTyped Name Signature <br /> Monfh OAY Year <br /> ,• <br /> fS 8022 A(1188) <br />'A 8700-22 Do Not Write Below This line <br /> ev.9-68)Previous edition&are obsolete. <br /> GREEN: HAULER RETAINS <br />