Laserfiche WebLink
tate of CaI fornia—Envircnm'enlal Protection Agency L <br /> Approved OMS No.2050-0039(Expires 9 30-99} See Instructions on DOCK OF E b. Department o1 Toxic Substances Contra) <br /> as$+prinl or type- Form designed For use on elite(12-pitch) ilex. _ Sacramento,California <br /> 1 Generator's US EPA ID No. Manifest Document No. �2. Information in Ike shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST <br /> Ciel A 'Sfnie Manifest Docutr t Number <br /> - 3. Generali s Name ailing Ad ress 1 ^ ` L� � ! t, � � Q _., . <br /> I *+ ,a= PL 'a'i <br /> CF"]IIII. '��►.f l� C�.h�r 4,, )r LU a�j � .�,Q� 1� -��c� v� !�;t <br /> J J �} l <br /> 4. Generator's Phone (Zb 5 t�! � 6 t 1 s � meg $ y <br /> Zn S. Transporter I Company Name b. US EPA ID Number C"`Siae Tran$portars I❑ <br /> co D Transporter s Pknne i 2 1V c § s <br /> E:Stale Trpnspbrter s ID. iq µ W <br /> 7. Transporter 2 Company Name 8- US EPA ID Number ! ' <br /> F;xTrartspartei s Phone -" „'�~•�, <br /> � <br /> G State Fanli s ID r ' <br /> 9. Desi noted Facility;Nome Pnd Site Address y 4 l0. US EPA ID Number <br /> ,r � '� a I�� T" e ii a•' fat, ,a � .c� .a,�< , <br /> n .r =. . .., J , z r• uxr r ,, 'r ka g,s 5Mal ' r�iza+.r_ <br /> - <br /> x+x <br /> 12. Containers 13. Total I4_ Unit e uma a _ <br /> 11 US DOT Description{Including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity WI/Vol I ,Woste Nber <br /> - <br /> t <br /> , V;t i s. f .¢511r 7 1 - tit 1f s•t- ."tt } � �-Y a S ? d ta. <br /> EPA/Olher <br /> G <br /> E State r _ rev a <br /> N <br /> OD E EPA/Other <br /> R <br /> ACL <br /> ;`- <br /> T <br /> �6 O <br /> w EPA/Other <br /> N <br /> W <br /> l escriris forMaterMdls Listed.Albove A r', " K.,.Handlirig Codes for Wastes Lined Ahove , <br /> 1.'Additionaptio <br /> F€ � © � a _ S _ � ` b: <br /> aT 1 a C is r ° <br /> LuY' ^" s`T.'r <br /> Kq� c c t gq a a a x c:. d T <br /> �vITYSI�i 71! ('& 4t '$ rt45jrk2 ys .izl � y X , X „s y "Niuy � A i <br /> l:• <br /> 15. Special Handling Instructions and Addi1 anal Information <br /> F <br /> Q415 C' 14 1 PrP tIpv (faar,.t-I .: tic 4" ft.l9f-I'i,a4 Ili ..7A tl ke:/to Ca�/i'7i].f a931 T. (15..r,yc^a}lt4i rr ♦.la .r s:+.s i..'1:-� rrax- -x;=r_a ix R:'d t. _a. .. <br /> -1;• -..6i, ...�J i IY':�.f y a,','. r k..fI �pp�/t JJJfi)) V � t <br /> { f': <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignmeintare fully and accuralely described above by proper shipping name and are classified,pocked, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I pm a lorge 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 to be economicalky <br /> vy predicable and that i have selected the practicable method of treatment,storage,or disposal currently dvoilable to me which minimizes the present and future threat to human health <br /> and the environment;OR, if I am a small quantity generator,I kove made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> � available to me and Shot I can afford, <br /> TMTI � <br /> � a '�7 yYa <br /> Printed/Typed Name SignaturDy <br /> Lu T 17. Transporter 1 Acknowled ement of Recei t of Materials <br /> ,.-t Month Day Year <br /> R of F f <br /> {`°~-' p Printed/Typed Nome Signature <br /> efif <br /> 0 18. Trans orler 2 Acknowledgement of Receipt of Materials <br /> TPrinled/Typed Name Signature Month Day Year <br /> W t <br /> R <br /> d 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> I 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered b this manifest except as Holed in Item 19, <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> TSC 8022A (4/97f Yellow GENERATOR RETA!r-!S <br /> PA 8700-22 <br />