Laserfiche WebLink
-e-9 ) See Instructions on back of page 6. Department of Toxic S bstanc s Con rol <br /> on elite(1 -pitch)ty- iter. Sacramento, .1,forn�� <br /> -<M HAZARDOUS I erator's US EPA ID No. Manifest Document No 2 Page 1 Information in the shade <br /> WASTE MANIFEST A �) 5 t C� 5 G is not required by Federal law. <br /> of <br /> 1 Generator's Name and Mailing Address A. State Manifest Document Number �[ <br /> �t 4 R t,.,, .,, 7""t <br /> {" 4 6 � <br /> 1 <br /> 210 S C.";EI'i(KEE LANE B. State Generator's ID v. <br /> h E.ODI, CA 96240 <br /> W) 4. Generator's Phone <br /> c(N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> 0o <br /> Or ?r T ?(. �.'ltLrnlF 1tJ} i' `v A D ( Pl 8 '2 C 2 4 M i� D. Transporter's Phone <br /> 00 7. om an Transporter 2 CN <br /> P Company 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> J <br /> "Q F. Transporter's Phone <br /> e V 9. Designated Facility Name and Site Addre s 10. US EPA ID Number G. State Facility's ID <br /> -< PACIFIC RESO(JRCE RECO 'ERY C A D S 0 8 2 5 2 4 Q) F <br /> r ZZ 3150 E A iT FSCO BLVD, H. Facility's Phone <br /> g 0 LOS ANGELES, CA 90023 C A D 0 0 8 2 5 2 4 0 5 ty �S�) 499-7145 <br /> J <br /> V11. US DOT Description(including Proper Shi ping Name,Hazard Class,and ID Number[ 12. Containers 13. Total 14. Unit <br /> No. Tye Quantity Wt/Vol I. Waste Number <br /> •�" ??`!'+' c �. .tk , State <br /> HReif 508 <br /> 3 G E A ther .. <br /> E <br /> N B Jb, tJ& ;C Faint Related Materia-, 3, UN1263, PETI State 21.4 <br /> co <br /> co E DMI. <br /> N R f G r ) <- EPA/Other <br /> v A f L <br /> 0 T -�iEAPFt+�'r?-E! C4 j. State <br /> R EPA/Other-� <br /> � <br /> wd. State <br /> t- <br /> Z <br /> LU <br /> V EPA/Other <br /> LU <br /> ZJ. Additional Descriptions For Materials Listed Bove K. Handling Codes for Wastes Listed Above <br /> ��c° c ter` w r. r• n�sr assn... a. b. <br /> LU ' L fi TF{J:d ER#PAII�tT' SLUDGE <br /> A00 FP t: FOC-2. FM3. F P151 - :.` d. <br /> Z 15. Special Handling Instructions and Addition I Information <br /> 94A I <,r:ur .C} 1113, AP# 6329 44@4 yPu 6"4- <br /> Q GLOVES. GOGGLES & PROT 'CTIVE CLOTHIING <br /> Z EMERGENCY CONTAC't - CHE TRF--*C+ 1-800-424-9300 <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby d clare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Q marked,and labeled,and are in all respec in proper condition for transport by highway according to applicable international and national government regulations. <br /> V <br /> IF I am a large quantiy 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 to be economically <br /> practicable and that I have selected the pro ticable method of treatment,storage,or disposal currently available to me which minimizes the present and Future threat to human health <br /> N and the environment;OR,if I am a small q antity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> O <br /> >- Printed/Typed Name « Signature Montly Day r Year <br /> Z 1 j'�1 C ;)� ret <br /> w R 17� Tr orter 1 Acknowled ement Receipt f Moteriold <br /> Cie p n�te��d�yped Name �? Si tJar e i / Month Day Year <br /> SK <br /> O0 18. Transporter 2 Acknowledgement of Receipt Materials V, 1 <br /> TPrinted/Typed Name Signature Month Day Year <br /> LU E <br /> LO R <br /> Q <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 20. F.c ility Owner or Operator Certification of r ei t of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LIGE. <br /> DTSC 0 (7/99) <br /> EPA 87700-0-22 Yellow: GENERATOR RETAINS <br />