Laserfiche WebLink
State of Califomia--Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30.96) See Instructions 011 back9e 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12pifo, writer. Sacramento,California <br /> UNIF®R HAIA�D®US 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST 7 of <br /> s <br /> 3. Generator's N e and Moilin Address � A. State.Manife&171—ument"Number <br /> dl <br /> 9,53314,474 <br />' ^ FTC" 7{�, B. State Generator's ID <br /> N �✓ W <br /> co <br /> co 4. Generator's Phone ®` <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID y <br /> °0 e11..:IGI C. :! DMI 'Oa, :'F'> TTL SERVICES40 <br /> G A 0 $ 0 6 9 5 7 1 D. Tronsporter's:Phone: dt1�} <br /> J 'ga <br /> J <br /> Q 7. Transporter 2 Company Name 8. US EPA 10 Number E. State-Transportee's ID <br /> U <br />` Q F. Transporter's<Phone <br /> Z 9 Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> H. Facility's Phone: (510) O` <br /> t u 4"A:t'f.Jaj I D JA P 19 $ 10 $ 18 17 14 11 13 <br />° <br /> t Z_ 11. US DOT Description12. Containers 13. Total 14. Unit(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantify Wt/Vol t. Waste*Number' <br /> = State, <br />( a. C) 6,. e— <br /> E NtlN- C11 HAZARDOUS WASTE,LICUiD 01011, 7 T � EPA/Other NONE <br /> o 00 N b. State" <br /> 4� E <br />! R EPA/Other <br /> 6 A <br />( 0 T C. State: <br /> O <br /> R EPA/Other <br /> i LU <br /> Z d. State" <br /> W <br /> U <br /> W EPA/Other <br /> v7 <br /> Z <br /> 0 J. Add'etlbnol.Descriptions-for Materials Listed Above w. Hondling<Codes for Wastes.Usfed Above <br /> a ; <br /> W <br /> Z <br /> 15 Special HandlingInstructions and Additional Information <br /> LU <br /> Ji 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 /> U packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> 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 /> CL economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> V) threat to human health and the environment;OR,if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. <br /> O Printed/Typed Name Signature Month Day Year <br /> U ® Ce <br /> U ir.1.tJ4f J <br /> Z T . Transporter 1 Acknowledgement of Receipt of Materials <br /> W R <br /> (, A Printed/T ped Name Signature Month Day Year <br /> W S <br /> P <br /> g O 18. runs orter 2 Acknowled ement of Receipt of Materials <br /> W T Printed/Typed Name Siglncftv6 Month Day Year <br /> p E <br /> LUR <br /> 19. Discrepancy Indication Space <br /> Q <br /> U FA <br /> Z C <br /> I <br /> L <br /> I 20. Foci Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Td/ in <br /> T d t� e Signa r ` Month Dayf J )ea r <br /> Y .14 � ��f� � ,rpt f' ,p '7f <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (9/94) <br /> EPA 8700--22 <br />