Laserfiche WebLink
State of California—environmental Protection Agency <br /> Form Approved OMI No.,2050T0039(Expires 9-30-99) See Instructions on back of a 6. Department of Toxic Substances Control <br /> Please print or type. Fotm designed for use on elite(12-pitch riter. Sacramento,California <br /> UNIFORM HAZARDOUS 1 Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> 9 �, -s is not required by Federal law. <br /> WASTE MANIFEST �} L of <br /> 3. Generator's Name and Mailing Address p $tate 6difestDocumentNumb' <br /> 1029 L 51CURIM am <br /> 1�C ��+rgg ppR�__ 9 <br /> YWI, �CA 99" 9--47 <br /> LO <br /> A. Generator's Phone ( Mtj=tj J= FjEj= E <br /> 5. Transporter 1 Company Name 6.�}US EPA ID NumberLO <br /> CP <br /> g y #a#�lrzrttspoYfetsS{3eservetf j ' 'y °. <br /> p RUM <br /> MIC !Y. } }' <br /> o? 7. Transporter 2 Company Name 8. US£AA ID Number tale TtansporWr 1#�jRe3etvexj ` <br /> F Tronspg7ter s Rgrn aT l <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number00 <br /> =0.+ Statepcthty s 1D.= <br /> Z I ` #1 FaaF}iTy's phone..' ie <br /> LOp :teal BAT D C A B Q 0 9 A 5 2 6 5a <br /> ' 4 <br /> U- EAST P911 ALTS 943Mfi <br /> Q12. Containers 13, Total 14. Unit <br /> V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> Wt/Vol <br /> No. Type Quantity 1 Waste idumbet <br /> Z oU RVAID UMIAL 3 IJIM <br /> II <br /> � . <br /> N E <br /> N b.UM 3 101 11 <br /> °' E <br /> v R <br /> o T c. <br /> (MM111USTa <br /> f � t <br /> RPrO E 301M EM � <br /> LU d. <br /> li- <br /> � 4 <br /> W ; <br /> d;A Ufra?1gl escry3#us�s fat 1+6#erlals �ter3`A ave F ;: fC. Hondling'Codes fae rites L 15100,Ab <br /> 51 �`,� <br /> W 9 �s. ti c 3„ - " a ': ' .,., i n A� �,, Y r �;kA t '.�1,"',;ai�i e4 <br /> gg- <br /> Q � eta. aZ x ati t � a .� <br /> v >w,t �..�aty.°3 ,. u., .�.` ,.r'` Kh §.,'z.E. .oA"s �a. $t� ,..i,s, `,2 x. 3. <br /> 0 15. Special Handling Instructions and Additional Information ' 24M. 4: M)=-= <br /> Q <br /> Z <br /> U.] <br /> f- <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> 2 if I am a large 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 economically <br /> 0- practicable and that 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 /> V) 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 /> Ce available to me and that I can afford. <br /> Printed/ pedName,e _',nm Signature .3 on, Dayr %-� a>' <br /> Z gip'.. <br /> LU T 17. Transporter'1 Acknowledgement of Receipt of Materials <br /> R <br /> tL p Printed/T 79'tl'""" Signature Month Day <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials ...........�''°� <br /> 0T Printed/Typed Name Signature Month Day Year <br /> w E <br /> N E <br /> Q <br /> U 19. Discrepancy Indication Space <br /> F <br /> Z <br /> — A <br /> C <br /> L <br /> 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> 217 DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />