Laserfiche WebLink
State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039]Expires 9-30-99) See Instructions on back of page 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12 ty Sacramento,California <br /> UNIFORM HAZARDOUS 1-��i'••..'ator's US EPA ID No. Manifest Docui„_,. No. 2. Page 1 Information in the shaded areas <br /> � is not required by Federal law. <br /> WASTE MANIFEST �,y11 "^y �`"f of <br /> 3. Generator's Name and Mailing Address r� A, State Manifest D'acument'Namber <br /> 07-0 20.67 1,50 <br /> O �.`., .Ait" o 4. A. Slate Generator's ID <br /> Md CA <br /> nA. Generator's Phoney ) <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[ e rve .] <br /> to <br /> d D. Transporter',Phone <br /> 7, Transporter 2 Company Name 8. US EPA ID Number E. Sfate Transporter"s ID .] <br /> I I I I I I F. Transporter',Phone <br /> Q <br /> V 9. Designated Facility Name and Site Address (� 10. US EPA ID Number G. Stale °aci ity's Id <br /> Z v v "� H, Facile y's Phone <br /> mn. ArE Y—K INC� SAN JOSE l s 1 0 4,021 SEV <br /> ^ Q s + I2. Containers 13. Total F114. i Z.'� " <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) Wo. TQuantity Wt/Vol I.Waste Number <br /> ZoState <br /> D �NONACRA� HAZARDOUS WA ST LIRUID EPA/0.11 ,TaA a" RFS"LUDGE(NOs,�,s 11 OT REGUL TED) <br /> State <br /> c N b <br /> � E EPA/Oiher <br /> v R <br /> 4711 <br /> .d' A c. State <br /> o T <br /> a0o Q EPA/Oth_., <br /> R <br /> State <br /> LU d. <br /> F--- <br /> Z EPA/Other <br /> LU <br /> lJ <br /> w <br /> N J. Additional DeserpPions for Materials Listed Above K. Handling Cedes for Wastes listed Above <br /> O a. b. <br /> 0_ <br /> in 14 0.1 <br /> LU c d <br /> J <br /> Q <br /> Z <br /> Z 1 S. Special Handling Instructions and Additional Information <br /> a mrST R(T 000000000 0-000-03 <br /> Z IMERe�ENCY RESP 800-,4�,qf.,�,`' 60( 24 I: R t e�; � �x t ETURN TO ENCRATO'R <br /> _ SK CORP 1��THQRIZZD TO �d&�"�"AIN I.ICEN wll D SEMS'EQU NT CARRIERS AS NECESSARY- <br /> F- <br /> -1 <br /> ECE SARY- <br /> t— �h,'' <br /> ."i 16. GENERATOR'S CERTIFICATION: I hereby declare that the coda ,;111, f�ttTnonY ar f I cc Vy described above b40rbper shipping name ai to classified,packed, <br /> Umarked,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 am a large quantity generator,I certify that I have a proggram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> o practicable and Ihat I have selected the practicable method of treatment,storage,or disposal currently available 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 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 Prints' Typed Name Signature } ^ ;i Moln DI y Ye <br /> th V <br /> -. <br /> w T 17. Traa or 1 Acknowled ement of Recei t of Materials <br /> R Si elute Month Day Year <br /> LU A rinted/T Name <br /> �° "' "�' _ <br /> LLJ P „ <br /> U_ 0 1 Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed Name ¢� Si ature Month Day Year <br /> LU E --I ---I--J-- <br /> `� R <br /> Q <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> I 20. Facili Owner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y _. I _ I —I <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A]1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />