Laserfiche WebLink
a� FROM :JIM THORPE OIL FAX NO. :1 209 368 1851 ul. 08 2005 11:11AM P4 <br />dole of Colifornio—EmironMenla( Protaction Agency <br />Form Approved OMB No. 2050-OG39 (Fxptses 9.30 991 See Instructions on 6dck o16fpage6, ' <br />Pleitse print or type. Form designed lar use on elite f 12•pficb) ypewritor, Department of Toxic. <br />Sacramento, <br />UNIFORM HAZARDOUS 1, Generators- US EPA ID No. Manifest Document No, 2. Paget Information in •tlho shat <br />WASTE MANIFEST G — ' f •� 1s not required by Fed: <br />1� of r <br />h <br />n <br />N <br />h <br />m <br />4 <br />O <br />m <br />M r� <br />y )J <br />-Q <br />_0 <br />"4 4 <br />Z <br />3 G <br />c;i E <br />coN <br />op <br />m E <br />N R <br />v A <br />o T <br />co O <br />R <br />Z <br />Z <br />A. Generators Phan®(�` ) <br />S. Transporter 1 Company Name <br />_ AMER11 'tlr"h* VA:L,i:4—t'Y W.A-"'T'E 01t- <br />7, Transporter 2 Company Name <br />4'i 4 r'-) t> � <br />i Y 1 r 1(�___(' � <br />6. US EMD Number <br />S. us EPA <br />9., Ds �? F :li N a tt Al( 10. US EPA ID Numb <br />Fr;)VER8 ANN- Oda 963f;7 L ki c1 <br />11, US DOT Description (including Propar Shipping Noma, Hazard Class, and ID Number) <br />a. .. �9�•?��'•��:�(xm �iih.�a4,�£�CtLr°;:; W�.�I'�'I..����I.i <br />C. <br />d. <br />13, Total I lb, Unit <br />4Y <br />15. Speciul Handling Instructions and Additional Information <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and of evrateir described above b(prop., shipping name and are elaslified <br />marked, and labeled, and are in all rospacis in proper condition For transport by highway according to app ;cable internationo and nalionol.goaemment regulatiotjs. <br />i <br />It I am a large quanta, generator, 1 eernty that 1 no o program m place to reduce the volume end toxicity of waste generated to the aagra. I have aetarminad to ba <br />practicabla and that I have selected the roclicable me o treatment, storage, or disposal currently avofloble to me which minimizes the prasont and future thr ' t to <br />and the environment; OR, if I am a small quontity generator, I have mode a good faith effort to minimize my ;waste generation and select the beet waste managet�ienl t <br />available to me and Ilial I can afford. 1 <br />Printed/i ad Noma T, <br />.4 <br />_ pp f Month I <br />>' YP r ; / i ,. ✓� R .w• J1 li _ - _ 1� / A. r . J.. .✓ 9: I ..,.e .I <br />Z <br />T <br />T7. Transporter I Ae <br />w <br />Printed/Typod Name <br />4' <br />p <br />W <br />� <br />w <br />R <br />S <br />' <br />W- <br />0 <br />•18. Transporter 2 r <br />7 <br />Printed/Typed Nome <br />W <br />N .R <br />E <br />U <br />19. Discrepancy Indi <br />Z <br />— <br />F <br />A <br />C <br />1 <br />G <br />I20. <br />Focilit Owner a <br />Printed/Typed Nome <br />T <br />Y <br />DTSC 8022A (1/99) <br />EPA 6700-22 <br />stances Contra <br />(fforttfa <br />areas <br />law, <br />I ie <br />Year <br />........ <br />SigriClure f Month I bay Year <br />id emen of Recei I•of Materials '� <br />Signolure Monlb Day Year <br />Space <br />I <br />clef Cerlificalion of roc.I t of hazardous materials covered bv Ws manifest exec t as noted in llem 19. Month Day Year <br />Signature <br />i <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow; GENERATOR RETAINS <br />