Laserfiche WebLink
State of Colifornio—Environmental Protection Agency <br /> Form Approved OMB No.2050-W39(Expires 9-30-96) i 3 See IriSfrUCt10�15 OI1 bGCIC Of 6. Department Sacramento, <br /> Toxic S California Centro <br /> please prim or type. Form designed for use an elite(i2-pitch) dmf Sacramento,CaliEornio <br /> w. 1. Generator's US EPA ID No. Manifest Document No. 2. Page 11j, <br /> ormation in the shaded areas <br /> UNIFORM HAZARDOUS ot required by Federal few. <br /> WASTE MANIFEST . { t 1 ,�.1} j y '_� :. g 7 of <br /> 3. Generator's Nome and Mailing Address A State Marofesl Document Number:9,66-51�}y� <br /> ART wYaTT r .:�; . .' <br /> 73 <br /> 6265 5 :EOOKED 'STICK 1----R. , STOCKTON. CA 95219 B Stele.Generaior's1D r <br /> CV <br /> W A. Generator's Phone (209 956-0264 <br /> v+ d 5. Transporter 1 Company Name 6. US EPA ID Number C Stide 7rons�wtte�s ID <br /> 0o NOR C A L.. OIL 1_: A D 9 S='' 4 17 2 55 Dil,Tr"ansportet�s Fisons <br /> _a <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E State.Trcm pone",ID <br /> U F, Transporter':Phone <br /> M Q ' <br /> � 9. Designated Facility Name and Site Address 10. US EPA ID Number G State F6cifthr's ID <br /> ME z CL1=Arr. INC. yj <br /> o <br /> 0 ;1570 ALMOND DFS. fi Facll"' Phoma � .r��r <br /> LO < SILVER LSPE.I NG 5. NV 094'2'91 IBJ � D S 2 � a � - 1 ! — Q <br /> 12. Containers 13. Total 14. Unit <br /> z 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) No T Quantify Wi/Vol -L Waste Number <br /> Z State i <br /> tom '= NON-PI--FRA HAZARDOUS WASTE L..I O s I U 223 <br /> 3 G A W A T E P.) t i f-.'I T T I. EPA/Other <br /> �i E <br /> v co N b. State <br /> co E 1_. <br /> 4 <br /> R EPAJOtIter <br /> A S <br /> o <br /> C. <br /> T <br /> 6- 00 T <br /> R EPA/Other } <br /> ZZ d +� <br /> ttr U 4 <br /> EPA/Other <br /> LU <br /> - - J.'Adddibnaf Descriptions for Materials Listed AbiiYe K Handling Codes foe ktlastes lrstod'Aboiie ' <br /> b <br /> LU <br /> -�•n om <br /> J - <br /> a <br /> Z - <br /> y O 15. Special Handling Instructions and Additional Information <br /> a APPROPP I ATE PROTECTIVE CLOTHING JOB SITE.: A I 0 STA T I ON j <br /> Z "EMERGENCY CONTACT :': _� : �rt �,2a�I�5�/ % ��/S 4511 PACIF IC ,'*,,'E. jI <br /> .. SLU EE E.R. G. - k STIOf_'k':-rm, t :r'1 �;- f, I <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, <br /> Upacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. I <br /> it 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 <br /> FL economically practicable and that I hove selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> rA threat to human health and the environment, OR,if I am a small quantity generator, 1 have mode a good faith effort to minimize my waste generation and select the best <br /> 0C wade mann ement method that is available to me and that I can afford. <br /> 0 Ptirrted/Typed Name Signature / �� Month Day Year <br /> / 1 <br /> 7. <br /> Z E 17. Tronsporter 1 Acknowledgement of Recei of Mater'ols <br /> 0 A Printed/Typed Name Signator -" Month Day Year <br /> N l <br /> W s TO P ETT i <br /> a. w0 18. Transporter 2 Acknowledgement of Receipt of Materials t <br /> u- 1 Printed/Typed Name i ignature' Month Day Year <br /> O E <br /> R <br /> ts!J 19. Discrepancy Indication Space <br /> tr.r U F <br /> A l <br /> Z C <br /> L { <br /> tr. I 20.'FacilityOwner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. i <br /> T Printed/Typed Name Signature Month Day Year <br /> y <br /> N44P r.. i <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A (1/9"5) ` Yellow: GENERATOR RETAINS i <br /> EPA 8700-22' <br /> tr _ _ <br />