Laserfiche WebLink
of Cahfornio—Environmental Protection Agency <br /> Approved OMB No 2050-0039{Expires 9 30 99) _ See Instructions on back of�ge 6. Department of Toxic Substances Control � s <br /> ae print or type Form designed for use on elite 112 pitch i� rater Sacramento,Coldornto <br /> 1 <br /> i 1ienerafor s US EPA ID No Manifest Document No 2 Poge 1 Information m the shaded areas ti <br /> UNIFORM HAZARDOUS is not required by Federal law f <br /> WASTE MANIFEST <br /> I <br /> 3 Generator s Name and Mailing Address �I e-f(0. LU rn)Q <br /> .Sr � <br /> 3-7 "64 zit tO( <br /> 4 Generators Phone (-),,4 ) <br /> f <br /> 5 Transporter 1 Company blame 6 US EPA ID Number f <br /> t 8 � <br /> ransporter 2 Company Name B US EPA ID Number <br /> i <br /> 9 Designated Facility Nome and Site Address 10 US EPA ID Number <br /> -AUSh�1C�i.. �gtdlCr, C) <br /> r <br /> IL <br /> 12 Containers 13 Total 14 Unit y <br /> 11 US DOT Description(including Proper Shipping Name Hazard Class and tD Number) No Type Ouontity Wt/Vol 11 lli <br /> sS1a-`td � <br /> G r <br /> E i <br /> Stara <br /> N b 1 <br /> EPS <br /> R <br /> A a 1 <br /> T ` <br /> t O EPA�or�,e <br /> R <br /> d <br /> Waste <br /> Lsted A'boyer .°w,E�; <br /> ���.�Ihona'1�?asci,pttaiss�atleital��iste�;�i�ave��' t � a �" d.,: .."� �•r^�.I� � � „�^9 <br /> Z <br /> i„T+"r�,rt_ <br /> y''r a w✓•S,�ir� `k3 ..fir r�- -. � 4 -��� g� s .,��`..Y_k 1�'�� � �`��'� L f� � �� �� :� "�"4° F "x � <br /> 15 Special Hondling tnstruclions and Additional Information T <br /> I <br /> G�L {� <br /> z <br /> rGr f?ntzI h q-1; <br /> 16 GENERAT S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping Home and ore classified pocked <br /> L marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and notionol government regulat ons <br /> If I am a large quantity generator I certify that I hove a program in place to reduce the volume and toxicity of en <br /> waste gerated to the degree I have determined to be economically <br /> practicable and that t hove selected the practicable method of treatment storage of disposal currently ovoilo61 to me which minimizes the present and future threat to human health <br /> end the environment OR if I am a small quantity generator I have made a good faith effort to mm$mize my waste generation and select the best waste management method that is <br /> k available to me and that I can afford <br /> P.riinieed/Typed Name 1 Month Day Year <br /> ! t. 1C, f I �, J^ <br /> 1 17 Trans orter 1 Acknowled ementlof Receipt of Materials <br /> A Signature Month Day Year <br /> A Panted/Typed Noma g s n <br /> '� <br /> PAc - ` V <br /> p "173 rams prier 2 knowled emenaof Recei t of Materials <br /> A Panted/Typed Name Signature Monlh Day Year <br /> T <br /> E I� <br /> A <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I I <br /> l 1 20 Facility Owner or O erotor Certification of recei t of hazardous materials covered by this manifest except as noted in Item 19 <br /> Printed/Typed Name Signature Monlh Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> 'C <br /> 8022A (1/99) Yellow GENERATOR RETAINS <br /> A 8700-22 <br /> 1 <br />