Laserfiche WebLink
^lNus.a(COlifomio—Environmertrol Pro ! envy <br />t > orm Appro.ed OMS No. 2050-=- Exp s 9 36.96) S@e Instructions an back age• 6. Department of Toxic Substances Contr <br />Pleose print or type. Form designed fol am on -Wit. nzaft .. ..Mi -A -A d i r t� � <br />DO NOT WRITE BELOW THIS UNE. <br />DISC 00-22 (1/95) <br />EPA 87700—Yellow: GENERATOR RETAIN <br />UNIFORM HA2US lenkige;U EPA D Manifest Document No. 2. Page 1 Information in the shaded areas <br />WASTE MANIFEST 9 5 of is not required by Federal law. <br />LO <br />3. Generator's Name and Mailing Address <br />-5ToGK��: UjiIriED SGML ,V15 4iC7— <br />LO <br />qd� EL R AM L PQ 5 rklJ 95, 65 rv;, <br />C4 <br />Ln <br />.j <br />4. Generator's Phone <br />5. Transporter 1 Company Name 16. US EPA ID Number <br />00 <br />e 6 } t 4 16 1 G � <br />iV <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />Z <br />9. �na.e F�cility NpmeCand Site Address 10. US EPA ID Number rF�ct �)r "^t <br />GK Oil til <br />09 <br />� <br />k Yy <br />255 Parr Blvd. <br />. a <br />RiChff-) id,CA. 94301 A D 0 0 9 4 6 6 3 9 2 <br />U <br />i <br />Z <br />11. US 00T Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14. Unit <br />F <br />n <br />No. <br />T <br />Quantity <br />Wt/Vol <br />1)Vosfr `' <br />ONON-RCRA Hazardous Kast.e Solid <br />.. <br />G Waste Eipty Storage Tar*. <br />T <br />P <br />EPl t <br />E <br />l� <br />COO <br />0 <br />/L• <br />N b/9 <br />Slant ; <br />EPA/Other „ I <br />O <br />AR <br />e <br />- <br />0000 <br />T <br />c. <br />.State <br />.- <br />O <br />LU <br />R <br />EPA/Other <br />H <br />Zd. <br />W <br />State <br />U <br />w <br />to <br />s <br />EPA/Other, <br />Z <br />CL <br />J Addk oval Deser'pt ons for Materials fisted Above ! <br />�' w....a <br />K Handling Codes for Waster <br />lasted Above <br />� <br />a <br />w <br />3). have been .1n, e _ y 15 <br />d _ <br />O <br />a <br />Z <br />15. S ial Handling Instructions and Additional Information. <br />:eek• aWaa prom so t,_cez Q)! lgi'fition. k advs wear hard' is when Lao king arOUnt3 <br />U . G, S. T. ' s, 24' fir. Ccx ctu -t [Jame i h[i r 1 �v1.e� Fbone CLf-0 <br />w <br />-9AA,- -=494 <br />F- <br />J <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br />U <br />packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />JIf <br />I am a large quantity generator, I certify that I have a program in place to reduce the volumeand toxicity of waste generated to the degree I have determined to be <br />4 <br />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future <br />N <br />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 best <br />Ck: <br />waste management method that is available to me and that I can afford. <br />O <br />Printed/Typed Name <br />Sign is <br />', <br />Month Day Year <br />v1K <br />t� t) J v <br />r <br />_ <br />Z <br />R <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />O <br />Atl <br />e,Printed/Tped'•� <br />tq—. <br />Signature _ <br />Month"`" Day Year <br />LU <br />S <br />- <br />_ <br />- <br />LU <br />R <br />18. Trani rter 2 Acknowled ement of Receipt of Materials <br />LL. <br />O <br />1 <br />E <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />R <br />19. Discrepancy Indication Space <br />Q <br />J <br />F <br />A <br />Z <br />_ <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Y <br />Printed/Typed NameSignature <br />Month Day Year <br />DO NOT WRITE BELOW THIS UNE. <br />DISC 00-22 (1/95) <br />EPA 87700—Yellow: GENERATOR RETAIN <br />