Laserfiche WebLink
State of California---Health and Welfare Agency See Instructions on Sack of Page o department ,i meaiih Sary cas <br /> Form Approved OMB No.2050--0039(Expires 9-30-911 Toxic Substances Control Division <br /> tepee printtK3;type. Fo ned for use on elite(12-pife`('ypewdter). andFiOnt Of 898 Sacramento,California <br /> NIFORM HAZARDOUS I 1. Generator's US EPA ID No. Manifest 2. age 1 j information in the shaded areas <br /> WASTE MANIFEST / / t N0' <br /> C ` of l is not required by Federak law. <br /> Yator's Name W.dm�ailin Ad ass A. State Manifest Document Number <br /> /dam GAT / C7f-��C- - .+C/�7,71--`� <br /> �,�� i� € 90777744 <br /> I / B. State t3eneratoes ID <br /> 4. Gener for's Phond �a ' B. <br /> l ,sr <br /> 5. Transporter 1 Company Name 8. US EPA ID Number C, r <br /> 'ftte.1taleporters ID <br /> LIDN � /x/77 a� ���. � D. Trarlaportsr's PfFOna <br /> m 7. Transporter 2 Company Name B. US EPA ID Number E. State Trasuportor's ID <br /> mF. Trans~*Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number 0. State 1=aCifWa ID <br /> "'���,•�VE . �''� H: Facility's.Phone <br /> O 12. Containers 13, Total 14. 1- <br /> �.LL 11. US DOT Description(Including Proper Shipping Name,Hazard Class,ind ID Number) Quantity Unit Waste No. <br /> �i n ../ No. Type Wt/Vol / <br /> U a �IWZ44 G.7l .,tL li 41KV7 N `/ state f <br /> F N l�l� .�f^/i G'/J ` i /47 6e::�rl! f PAIOmer <br /> 3 E b. <br /> R State <br /> A <br /> m T EPA/Other <br /> v O <br /> N <br /> `r R C. State <br /> m <br /> EPA!Other <br /> W d. <br /> W <br /> r, State <br /> Z <br /> W <br /> U EPArOthar <br /> W <br /> Z <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes listed Above <br /> fiCc.�'•/ <br /> �+ [. y�� <br /> C. d. <br /> O e rt <br /> P 15. Special Handling Int�yctlons and Additional Inferration O GENERATO <br /> � �� +✓�{ <br /> J r 1J <br /> U 18. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> r4 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 <br /> O to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> present and future 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 <br /> >• generation and select the best waste management method that is available to me and that I can afford. <br /> wZ <br /> Printed/Typed Name .-� Signature..--, I,/ Month Day ,Year <br /> 0 <br /> w f 2./,ij/c, <br /> wT 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R .. . <br /> Z A Printed/.Typed Name Signature _J Month Day Year <br /> ¢ N <br /> LL S <br /> O P <br /> 1 71 _710 Cil <br /> W O 18. Transporter 2 Acknowledgement of Receipt of Materials 71 <br /> R Printed/Typed Name Signature Month Day Year <br /> U T <br /> E <br /> Z <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I • <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> .� y ed/Typed Name Siynatura Month Day Year <br /> DHS 8022 A Do Not Write Below This Line <br /> EPA 8700-22 <br /> (Rev.8-89)Previous editions are obsolete. <br /> ;%, :r'^i:': `HIS _'CPY 'G GENERA-CRWITHIN 30 DAYS <br />