Laserfiche WebLink
f - <br /> State of Colilomio—Environmental Protecsion Agency - _._I <br /> Form Appriwed OMB No.2050-0039(Expires 9.40.94) See Instructions on back of nage 6_. Department of Tock Substances Control <br /> . Please prinflo'r type. Form designed for use onlefire(12-pitch) r. ( Sacrament.,California <br /> UNIFORM HAZARDOUS rator'�EPAAID Manifest Document 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST is not required by Federal law. <br /> � A_- C, 6 75 9 3 7 3 11 of 1 <br /> 3. Generator's Name and Mailing Address <br /> C:OhIPFFTE I AIC _ <br /> in <br /> 749 SO. STANISLAUS. STOCKJO('4, CA 97)206 <br /> N 4. Generator's Phone <br /> 00 <br /> a 5. Transporter I Company Name 6. US EPA ID Number <br /> toNOP C'AI"" ❑IL. 1� AD 9 92 4 17 5;5 i <br /> 7, Transporter 2 Company Name R. US EPA ID Number ' <br /> Q <br /> V <br /> ; i <br /> a 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> 100 z <br /> Co Q PP17 PATI'PF.SON, <br /> N1 1,^'33I NOrtTFt HWY. OS <br /> Ma 1 r (4 - .11 66 1 7 ' 3 <br /> U 12. Containers 13. Total 14. Unit <br /> 11. US DOT Description{including Proper Shipping Name,lfa;ard Class,and ID Number) <br /> z No.. Type 61uan• WI/Vol <br /> mX <br /> 3 Idl3f.l F' F A I'IAZAPT)OL IS WA TE E.I rUI D <br /> tv E <br /> N Is, <br /> ot R I <br /> A <br /> T C. <br /> O I <br /> � R <br /> W <br /> z d. <br /> ur <br /> U <br /> lu <br /> Ln <br /> O <br /> a <br /> LU <br /> 1 <br /> a <br /> z <br /> 0 15. Special Handl-mg Instructions and Additional Information <br /> 7 <br /> a APF`PICIPP.I ATE PROTECT I VF CLOTH 1 t%ir <br /> i <br /> Z ^EPIEPriENf**Y (_UNTAC'T r r 2().0)GC.7 EAG- " <br /> LU SEE E.P.G. 34 <br /> W <br /> r 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are Fully and accurately described above by proper shipping name and are classified, <br /> packed,marked,and labeled,and are in all res mproper condition for transport highway according to applicable federal,state and international lacus• <br /> a p respects� sp by g way ng Pp ) <br /> U <br /> If I am a large quantity generator, I certify that I have a program in place to educe the volume and to icily of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of tri sMroge,or cu ly avoilable to me which minimixes the present and Future <br /> a' threw}To human heaHh and the emiranmenf;OR,if I am a small quantity g ator,J have mad tt o mi;q my waste generation and select the best <br /> tr <br /> waste management method that is available to me and that I tan afford. lftt' �` 1JJJ <br /> O Print Typed Name Signature� mh �V r <br /> z T 17. Transporter 1 Acknowledgement of Receipt of Material <br /> y. <br /> I" A Printed/Typed Name Signature f Day ear <br /> � L - <br /> O 18. Transporter 2 Atknowled mend of Rec ' 1 of Material <br /> LU <br /> j Printed/Typed Name Signature Month Day Year <br /> U_ e <br /> O <br /> lIL 19. Discrepancy Indication Space <br /> a F <br /> V A <br /> z C <br /> t <br /> L <br /> 1 20. FacilityOwner or Operator Certification of receipt of hazardous materials ravened this manifest except as nosed in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> OTSC 8022A (7/92) - <br /> EPA 8700-22 - Yell—: 'a t flat.•,l i'F <br />