Laserfiche WebLink
. i <br /> State of Colifomio+Environmental Protection Agency <br /> .Form Approved OMB No.2050-0039(Expires 9-30-96) S@@ Instructions On back Of 2aae 6. Department ra Toxic Substances Contra <br /> Please print or type. Form designed for use on elite(12 pitch r. Sacramento,California <br /> UNIFORM HAZARDOUS venerator's US EPA ID No. Manifest Document N 2. Page 1 Information in the shaded areas <br /> is not required by Federal lave. <br /> WASTE MANIFEST 01 n1 A A Iof <br /> 3. Generator's Name and Mailing Address "tI� <br /> RMC LONESTAR J ; <br /> P.O. BOX 5252, PLEASANTON. CA 9 .566 <br /> tn4. Generator's Phone ) _7 <br /> C) 5. Transporter 1 Company Name 6. US EPA ID Number " MAN <br /> U11 lit, <br /> � � <br /> 9 <br /> s <br /> g 4e b . <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> NOON <br /> Q <br /> Z 9. Designated Facility Nome and Site Address 10. US EPA ID Number <br /> 14 & H SHIP SERVICE COMPANY - <br /> C-' J 220 TERRY FRANCOIS/CHINA BASIN <br /> a AN FRN 4 ... <br /> LO V 12. Containers 13. Total 14 Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) s <br /> Z No. T Quantity Wt oAll <br /> /Vol f, ; <br /> RESIDUE DIESEL. TANK <br /> G NON-RCRA HAZARDOUS WASTE SOLID 0 T P � <br /> 00 Nb. State" <br /> 00 <br /> - -� <br /> �y R EPAG>fhep d <br /> 00 <br /> O RESIDUE OIL TANK <br /> R NON-RCRA HAZARDOUS WASTE SOLID 0 T P EPA.Uj <br /> I a <br /> Z d Staa <br /> W ✓, i'Q <br /> LU <br /> Z }�` g "�ff�dl Codes for Wastes Lied AfSave �" <br /> 0 <br /> CL <br /> Lu <br /> c19 <br /> Z .� <br /> 0 15. Special Handling Instructions and Additional Information <br /> t– <br /> a 083116507 JOB SITE: <br /> ,Z 4 Hr. Emergency Contact: H&H #(415) 543-4835 30350 SOUTH TRACY BLVD. <br /> EAR APPROPRIATE PROTECTIVE CLOTHING TRACY, CALIFORNIA <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. <br /> If 1 am a large quuatity generator, ! certify that 1 have a program in place to reduce the volume and toxicity of wane generated 'a*,a dayree I hcve determined to be <br /> a 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 /> 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 /> 0 Printed/Typed Name`1 Signature f Month Day Year <br /> ura� 1� Sof i.t 57 ,,• d_ '' 1 3Ig 16 <br /> Z p 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> A Printed/Typed Name Sigr)a(ure Month Day Year <br /> W s JIMMIE H. REESE ,��.�'�- 1 2 3 9 6 <br /> P <br /> W 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> U- F Printed/Typed Name Sig re Month Day Year <br /> 0 E <br /> N19. Discrepancy Indication Space <br /> Q <br /> U FA <br /> ZC <br /> _ 1 <br /> L- <br /> I 20. Facili Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/95) Yellow: GENERATCR RETAINS <br /> EPA 8700-22 <br />