Laserfiche WebLink
e State of California—Environmental Protection Agitky <br /> Ni^r pproypd OMS No.2050-0039(Expires 9-30-99) See Instructions on back of a 6. Department of Toxic Substances Control <br /> ,d a print or type. Form designed for use on elite(12-pitch) rifer. Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS B 7 4 6 4 2 D 9 1 } of 2 is not required by Federal law. <br /> t WASTE MANIFEST I <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> WMI now, <br /> S.%QMM SIM <br /> 8. State Generator"s ID <br /> LWICA 0249-0% <br /> LO A. Generator's Phone( p <br /> N 5. Transporter 1'Company Name 6. US EPA ID Number G. State Transporter's ID[Reserved.] <br /> LO <br /> 00 <br /> 6 Ix` EIVIRONKMAL T=- 0 11 S 4 S 2 18 g 9 D. Transporter's Phone <br /> Q <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID IReserved.] <br /> F. Transporter's Phone <br /> Q <br /> V 9, Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> 5 71 <br /> Z Rmic EIVIMMIEV& 8S <br /> W 1 BAY C A D 9 9 9 4 5 2 S 5 H. Facility's Phone (659)324-IM <br /> EA9 PAM ALM CA <br /> -� 12. Containers 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> V No. Type Quantity Wt/Vol I. Waste Number <br /> ' Z a, State <br /> 3 G Wit 1 129 G I. EPA/Other <br /> �✓' ;- <br /> o N b. stare <br /> co E EPA/Other <br /> N R 2# E 7 129 913T' <br /> 2. ..: <br /> Zt A c State. <br /> o T214 <br /> ao O <br /> EPA/Other " <br /> R Prf2# E 341372 MIN 129 00OIL71919161 . <br /> .0. j W State .rq ,... <br /> Z <br /> Prfl# E 391247 EM 128 V101Q1 <br /> d ity'��IDkP +a vl s Above K. Handling Codes for Wastes Listed Above <br /> BiA. b.O <br /> W �, �, x t `xu ✓ <br /> 0 15. Special Handling Instructions and Additional Information I - <br /> JMZ <br /> LU <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shippling 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 regulat`o?rs. <br /> i <br /> J 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 /> practicable and that I have selected the practicable method of treatment, rage,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 d faith effort to pCinimize my waste enera tion and select the best waste management method that is <br /> Oavailable to me and that I can afford. <br /> P 5ioTyped Na/m� Signature i > Month Day /Y"�ear <br /> Z 10110I <br /> 0 7 17. Trans orter 1 Acknowledgement of Receipt of MaterialsName <br /> ! a <br /> R <br /> LU <br /> N Printed/Typed <br /> �� _' � � Signae Month Da `Yea <br /> Y T <br /> W s r -� G ' <br /> U- 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month A ay Year <br /> LU E <br /> Q <br /> R <br /> U F 19. Discrepancy Indication Space <br /> Z A <br /> C <br /> I <br /> L <br /> f 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> j Printed/T ed a Signatur, Month Day Year <br /> V. <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow:- TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> 1 99 (Generators who submit hazardous waste for transport out-of-state, <br /> DTSC 8022A <br /> ( � ) produce completed copy of this copy and send to DTSC within 30 days.) <br /> EPA 8700-22 <br />