Laserfiche WebLink
Store of CalrfOrrwi-�Vltlil Protection Agency <br /> Farm Approved OMB No 2050-0039(Expires 9-30941 See Instructions an back of page 6 Deporhowe of Tone Subdone:ers Cont <br /> Please Pnnr or" Form designed for use on IMI(12prrch)l)penroter Socra ardo Cakfoma <br /> UNIFORM HAZARDOl1s I Gonewtor's US EPA ID No MandDocumento <br /> est N 2 Paye m 1 Infonnahon the shaded areas <br /> n rot required by Federal law <br /> WASTE MANIFEST CIAIC101010111513t" 11 010 1 01 01 1 of t <br /> 3 G«rrator's Norrie and Mailing Address <br /> CWjW <br /> LM VWt stl"1lotg stoieftmll, CA 9= <br /> h 4 Generator's Phone ( 948—IMIL <br /> d S Transporter I Company Name b US EPA III Number <br /> m F. GO= , 1wCAD476557370 <br /> J <br /> Q7 Transporter 2 Company Name B US EPA ID Number <br /> U <br /> a <br /> 9 Denynared Foalry Name and Sae Address 70 US EPA ID Number <br /> RnU.O <br /> ei <br />•eta 33, Patt�lm, CAF �1,313111616171218 <br /> U <br /> I i US DOT Description 12 Conteuners 13 Total 14 Unit <br /> Z prion(including Proper Shopping Nome Hazard Class and ID Number) No TQW.My Wt/Vol <br />�3 asml-� HAZARD= LAW <br /> rC4 E 010J IT 01 Y a oL-) <br /> m CO N b <br /> E <br /> e <br /> [V R <br /> � A <br /> $ T <br /> W 0 <br /> U.1 R <br /> Z d <br /> W <br /> U <br /> W <br /> in <br /> be <br /> W <br /> W }+x <br /> Q 15 Special Handling tnstrudrpn and Additional Information <br /> z U=- S A I? SA Y AM _ P907EC E GMR. <br /> 14'II( = CCtM&M NUMM 209-448-1=1 <br /> W <br /> --� 16 GENERATOR S CERTIRCATfON I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified <br /> I V packed marked and labeled and are m all respects in proper condition for transport by highway according to applicable federal stare and imernotiorwl lairs <br /> 'f I am a large quctody generator I comfy that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically proefcable and that I hove selected the practicable method of treatment storage or disposal currently available to me which minimizes the present and fixture <br /> to threat to human health 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 bast <br /> IX waste manciaoment method that is available to me and that I can afford <br /> 0 P /Typed Name Signature Month Day Year <br /> U '-".. Ute N d s .=r Nr -amu ,,, > L, 3 3 ► 9 <br /> Z T 17 Transporter I Acknowledgement of Receipt of Materials <br /> W <br /> Printed/T Name Sig MortHs Year <br /> W s d �� 0 3 311 '9 3 <br /> � � i8 Trans r 2 At:krowled of Receiptof Materials <br /> u T Pnmed/Typed Nairne Signature Month Dory Year <br /> 0 T-1 <br /> to 19 Dsscroponcy Indication Space <br /> VF <br /> A <br /> Z C <br /> I ` <br /> L i <br /> t 1 20 Fanf Owner or agar Certification of race' of hazardous rna*enals covered by this manifest a as noted in Item 19 <br /> I T Pnrttad/Typed Name Signature Month Day Year <br /> Y II <br /> E <br /> DO NOT WRITE BELOW THIS LINE <br />' DTSC 8022A (12/91) <br /> EPA 8700-22 fellow GENERATOR RETAINS <br /> 1 <br />