Laserfiche WebLink
A 0 b i s V206 4427159TOSCO SEATrFLE —�0� <br /> Slate of Cahformo--Enntanmentol Prvtectiorj Agency <br /> Form Approved OMB No 2050-0039(Expires 9 30-961 See Instructions an back of page b 0itportment of Toxic Substancas C�nnrl <br /> Please pant or{ypoForm designed for use on ehse(J2pitchJ ypewrrter t ( l� Sacramento Cahlvrmo <br /> I Generator s US EPA 10 No Mcrrid t Document No 2 Poge l� Ireformalion in the shaded areas <br /> UNIFORM HAZARDOUS <br /> V17 <br /> f7 � � ! is not required by Federal low I <br /> WASTE MANIFEST' I_ti y p1 7 4 r ? <br />' >�- <br /> 3 Generators Nome and Marling Address `� tA�t.�tot4Mantlgst='DorumeitF N!}mbrrr''% <br /> (Al� 7 t �tL�e.,♦eryl Act��� � y ..�� <br /> /._ _� r t Tr.M�S'�ri=.r-•.. r.--4 4 t :te i. }�,Xs• <br /> rlrJ8'I�Sfa�feYtxneraloK sz{D'.r"'ry�:z14a . <br /> `� <br />' co 4 Generator's Phone �r`! 7: c F fry t e -tea�rti i r# _ <br /> co" 5 Transporter 1 Company Nome 6 US EPA ID Nsjm!�jb r G'; rsspa yi �>I <br /> 05 F t <br /> —w�A <br /> sporte <br /> 7 Transporter 2 Company Name 1 8 US EPA ID Number } S ns;-tg �S�rID:s't-"'s` <br /> Q : i,! r`.r�.„r.4 .4¢r.e�s a t4'•r a. .�}i <br /> vrl 1 I 1 I I F;�falsspbrtelrPhone� -Y^=t�• SFa:ee as> t : <br /> Q _ <br /> Z 9 Desrgrla`e�4FaljJr PlaineD and Site Address LO US EPA ID Number G`}Sfaee Foalrty's1ft ' X * <br /> r• lJ '1 r i H" Facrlrty�s Phoney-`- ,f <br /> V Mt"'a _ �ti ria"-^.F 1A.➢tS�-a�`"yT[� <br /> 12 Containers 13 Total 14l <br /> Unit <br /> Z 11 US DOT Dcscriphon(snciudinq Proper 5hipping Nome Hazard Class and ID Number) No T e Quant Wr/Vol -lgp;a gf fy lj'.f<° <br /> >_ tX_V 'i�l�.•-, '-ri"-ti � "1_ Gr.-c�t� rr � •r � -.� <br /> S-4aSt- F)riq r i E0 yc14 E <br /> �aLrr;l-�,;.s•- J ` <br /> cc N b SiCIO <br /> i[e � ,sr <br /> C4 R -EPAfo' —AWN'-12 <br /> A ; <br /> 00 <br /> O <br /> R } EPh1pfier ycr f_ <br />' LUL, <br /> d <br /> rn �•f .�.�--.�— <br /> Z Jt,q re,rotfalh <br /> tf3ei bons for Matertals L1si*d Abcn =`' '*` r ,Y h Y K Hand IngCaries for Wastes Listed Above r <br /> �v -'470rage_Tai* t# , ri ' ° a �J�`Of <br /> 1, <br /> Y <br /> raft}W7�g`.bey Tda Fee T.CfQQ' Can _ 3 a� rr'w sr, u_ - -' . � d, <br /> 0 15 Special Handling instructions and Additional Information <br /> Q Ki3'1 f I k}l t Z- AJ-1 i S r 1- IMM F rrr-lL r:t I1 ITS ;'l` } <br /> 'juel 7 <br /> w 1 <br /> S <br /> 16 GENERATOR S CERTIFICATION I hereby declare that she contenrs of this consignment are fully and accurately described above by proper shipping name and are classified <br /> Q 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 /> 1 1 If 1 am o large quantity enerator I certify that i have o program rn lace to reduce the volume and taxed of waste generated to the de vee E have: detennintd to be <br /> .1. 9 4 tY 9 Y p 9 p toxicity g 9 <br /> a econarr4ally practicable and that I have selected the practicable methbd of treatment storage or disposal currently available to me which mrmmixes the present and futurr <br /> LA threat to human helahh and the anus snmenir OR if I am a small quantity generator I have made a good faith effort to mwtimize my waste generahon and select the best <br /> og waste mono omen,method that 11 arorloble to me and that I can afford <br /> 0 Prr d/Typed dame S' ro. f Month Day Yeay- <br /> Z T runs orter 1 Aeknowled einem of ecet t of Materials <br /> LLJ II <br /> I Prml yped Name Sig ry �� Month , Day L/ <br /> "Yea, <br /> I Pirme <br /> LU <br /> r it <br /> 0 18 Transport Aeknowled einem of Recei t of MoteneF <br /> L f Printed/Typed Name Segnoture Month Day Yeor <br /> 1 LLI <br /> LI R <br /> ul 19 Discrepancy tndecalson Space <br /> Q F <br /> U <br /> A <br /> Z C 1 <br /> 1 I1 <br /> L <br /> 1 20 F)6cil-ty Owner or Operator Certification of recur r of hazardous material c vexed by this manaosi exce f as poled on Nem 19 <br /> T P, ed/Typed Name J Siq re Month Day Y.ar <br /> - <br /> DO NOi WEI BELS TjS iJNE <br /> Yellow IynF SENDS THII (-G] ) r 'ATH i + _ <br /> iGenerator who uhmrt h, i t it i irons, z <br />' DTSC 8022A (1/Y51 praouce compi.t.ri r pr n rF , j _ frr' <br /> EPA 8700--22 <br />