Laserfiche WebLink
State of Colifornio—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9.30-991 See Instructions on bock of pomb. Deportment of Toxic Substances Control <br />%ease print or type. Form designed for use on elite (12-pikhl &iter. Sacramento, California <br />0 <br />srI <br />h <br />N <br />M <br />tb <br />0 <br />0 <br />aD <br />6g 0 J <br />8/V <br />�Q <br />r-jz <br />CO O <br />(Nis V <br />P`A <br />Ce <br />w <br />1.2Z <br />w <br />V <br />in <br />Z <br />O <br />V) <br />W <br />a <br />Q <br />Z <br />O <br />a <br />Z <br />W <br />DO NOT WRITE BHIS LINE. <br />^" White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 8022A (1/99) <br />To: P.O. Box 3000, Sacramento, CA 95812 <br />EPA 8700-22 <br />UNIFORM HAZARDOUS <br />1. Generators US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />�/' <br />ICA <br />is not required by Federal law. <br />P 19f q 'J 1 17 18 5 11 <br />A <br />3. Generator's Name and Mailing Address <br />A.. State Manifest Document Number <br />STOCKTON USD /TRANSPORTATION DEPT <br />� <br />22817851 <br />2 2 S 1 7 H 5 1 <br />296��3((��S��((ATTN((��G((��UINETTI LANE ATTN• KEITH NFI SON <br />B. state Generators ID <br />d9MiAfbTdrWone ( 209 �53:4084 CA 95205, <br />5. Transporter I Company Name 6. US EPA ID Number <br />C.. State Transporter's ID [Reserved.) <br />ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6: <br />D. Transporter's Phone <br />600.97 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID (Reserved.) <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State F cil' 's ID _ <br />DEMENNO/KERDOON3 <br />,& <br />H. facility's Phone <br />2000 NORTH ALAMEDA STREET <br />7 10 18 10 10 11 13 13 15 12 <br />2101537-7100 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Numberl <br />12. Containers <br />13. Total <br />Quantity <br />]A. Unit <br />Wt/Vol <br />I. Waste Number <br />No. <br />Type <br />°. <br />State <br />NON RCRA HAZARDOUS WASTE LIQUID, (OILY WATER) <br />EPA/2D <br />G <br />0 <br />T <br />0;'71,0 <br />G <br />E <br />N <br />b. <br />s ate <br />E <br />EPA/Other <br />R <br />T <br />c <br />State <br />O <br />It <br />EPA/Other <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials Listed -Above <br />K. Handling Codes for Wastes Listed Above <br />11A) 224904 <br />°` ! b <br />C. d. <br />15. Special Handling Instructions and Additional Information <br />USE PPE �� EMERGENCY CONTACT :CHEMTREC 1-800-424-9300 rn, <br />WVb <br />NAERG #: 11A. 171 <br />SITE: TRANSPORTATION DEPARTMENT, 1932 N. EL PINAL DRIVE, STOCKTON, CA 95205 <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, pocked, <br />labeled, in in for transport by highway to international <br />marked, and and are all respects proper condition according applicable and national government regulations. <br />If I am a large quantity generator, I certify that t have a progrom 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, storage, or disposal currently available to me which minimizes the resent and future threat to human health <br />and the environment; OR, if I am a small quantity generator, 1 have made a good faith effort to minimize my waste enerotion and sel a best waste management method that is <br />available to me and that I car. afford. <br />Pri ted/Typed Nome <br />Signature <br />Month Day Y <br />� <br />TR <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Printed/Typed am\e <br />Si <br />Month Day Year Yea`r� <br />N <br />S <br />ci q d J <br />D8. <br />Tran rter 2 Acknowled emenl of Receipt of Materials <br />SPrinted/Typed <br />Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />i <br />2 Facility Owner o erator rtification of receipt of hazardous materials ccwered by thi ma ifest except as noted in Item 19. <br />T <br />Y <br />ri /Type Nom <br />Q Q� <br />Signature <br />/ontk Day YX <br />o <br />//� <br />��4 <br />DO NOT WRITE BHIS LINE. <br />^" White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 8022A (1/99) <br />To: P.O. Box 3000, Sacramento, CA 95812 <br />EPA 8700-22 <br />