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. DLA--200-;-90-D-0039 Dell 0 0170 " ' '3t}F3#. 26185%DePar orNe nsery <br /> IM <br /> State of„A" dhh aid Wallas Agency <br /> �. See Instructions an bask of mome 6. Toxic SeRnstanoes contra Program <br /> prhFor Form cb fa core on oite f 12-och era to.0oa <br /> UNIFORM HAZARDOUS 1.Generator's IS EPA 10 No. !--West Document No. 2 Pope i IMornich Intheshodedoreas <br /> WASTE MANIFEST l i t t l i l l t813121 if 31 ' 1 4 <br /> Is not required by Federal taw. <br /> 3.Generators(dame and Moring Address :A.Slcxto'ManQeat t)acume(it Aamber - <br /> Defense Distribution Region West (Sha= Site) <' <br /> tae narator} , <br /> Rouagh & Is , Stockton, CA 95 p3 = Y « $$ wr �<; ; <br /> 4.Gene ors Phone( ) '.::;#<.`i:::: <br /> 5.Transporter 1 Company Nome 6.US EPA 10 Number ?; State.Stouuportersl0 i,• ` <br /> Northwest EnviroService, Ing. W1111Dl0 5 813 i I71 <br /> 1.Transporter 2 Company Nam 8.15 EPA ID Number {.got 0.irdPupoft®f!10 r.:........... <br /> 1 I t 'I P t 1• i f 1 1 'F,.Ttrnist�oiiePs Pho+Ye'>.....:_ x.•. r::.+.;.; <br /> 4.Designated Facility Nome and She Address 10.tS EPA ID Number <br /> Abrttmst EnviroService, Inc:: <br /> 1500 Airport Way South <br /> co i 1 0 islet 310;1-" 11 1 I ` } <br /> dQj 11.US DOT tion( r Sri cam. IDNumber) 12.Contemn 13 Told Td Uri <br /> No. Type <br /> Quardu Wt/Vol ',f Wlaste tJtsmbet :n <br /> a she ' t fix. <br /> at <br /> U G <br /> us waste solid <br /> E I t DIM I t r P <br /> Z N ° X Reside t t 1 1 1-tri ra- <br /> 0 E r t {� w <br /> R. thane 174] <br /> side <br /> ? T a. X iaue t last contained petroleun <br /> R distillate 1271 a......,. <br /> slat :>Ft.<, p; >.:... <br /> 4 <br /> vNon- ou3 waste liquid <br /> CV 01 Oil Dim, 0 01 0t ' 10 G <br /> J anal Dalxxu,tor NlaterloglJste�!Above F &4 � ,,, � K,Hadtn®.Codes!or Wades fated Above <br /> LU <br /> est-,� <br /> (j 15.speca honalog Instructions o nal icorLU 7 L !�r} •a` <br /> J \ I °°wm <br /> o ( }a MAD - <br /> Cn <br /> ui <br /> # 1351 *** MR 24 HOUR RESPONSE INFORQgIONie CALL (206) 622-1090 <br /> q 16. GENERATORS CERTIFICATION: i hereby declare that the contents of this consignment are fully and accurately described by proper shipping twine and oro ckxshbd, <br /> Z pocked,masked,and labeled.and are In ON respects in proper condition for tionspod by hWvwcy o=xdno to applicable Irdemol loth and national inns. <br /> Oa I an o age quaMly generator.i c"Ify thd I have o program In place to reduce the vokxne and toxichy of vete generated to the degree I how determined to be <br /> Z economicallypracticable and 0 selected the prcoticabte method of tredmeM.storage.or disposal cureeruy to me whkh min s the present and future <br /> uy tMeat to human health and the environment:OR,t 1 an a stall Quantity generator.l taw o good faith effort to tm my waste generation o d select the best waste <br /> management method that is avolloble to me and that I can afford <br /> CPrintecoyped Nome. a Month Yea <br /> �tr1c,a. e „ <br /> j <br /> F7.'TAcknowledgementl <br /> porter 1 Acknowledgement of Receipt of Materia <br /> 0 R PmtedRyped Spnatus® Month Day Yea <br /> O A <br /> WSZ N L'�Sau <br /> 2 i <br /> o 18.Trac er 2 Ackrowie ement of Rece t Materiae <br /> LU <br /> ::> R Pmted/typed Nome Month Day year <br /> w T <br /> LL E <br /> 0 R <br /> Q F 19.Discrepancy indication Space <br /> V A <br /> Z c <br /> 1 <br /> 1 20.Facility Owner or Operator Cehficdion of receipt of hazardous materich covered by the monhest except as noted In hem 19. <br /> T Prnted/lypad Name Signdnxe Month Day Yea <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DHS 8022A(12/90) <br /> 1 Bhte: GENERATOR SENDS THIS COPY TO DHS WITHIN 30 DAYS. <br /> EPA 8100-22 To: P.O.Box 400,Sacramento,CA 95812-0400 <br />