Laserfiche WebLink
`t StpteofCfalitarnia-tppvironntal Protection Agency k �! <br /> Famm,ppidV&OMB 1Ny-2050 0039(Expires 9-30-99) See Instructions on back of p Department of Toxic Substances Control <br /> Please print or type. :Form designed for use on elite(12-pitch)type Sacramento,California I <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information.in the shadedareas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST <br /> ' [ of <br /> Gener tar's Name and Mailing Address f A. State Manifest Document Number <br /> e . a � 41 20244787 <br /> O ® p r B. State Generator's ID <br /> in 4. Generator's Phone <br /> N 5. Transporter 1 Company Name b. U EPA ID Number C. State Transporter's ID,[Reserved.) <br /> h 9 <br /> au <br /> O D. Transporter's Phone <br /> _ I <br /> OP 7. Transporter 2 ompany Name 8. US EPA ID Wum6er E. State Transporter's 104Reserved.f <br /> k(' A, ... F. Transporter's ®. -7_ -7° <br /> 9. Desi Hated Facility Name and Sit Address 10. US EPA ID Number G. State Facility's ID <br /> , apA; yP - tf�] y H.Facility'�,31o� <br /> honerp <br /> q o d�`t -7- I I� <br /> Q <br /> 11. US DOT Description(includingProper Shipping Name,Hazard Class,and ID Number 12. Containers 13. T I 14. Unit <br /> NJ <br /> V p p pP 9 ) No. Type Quantity Wt/vol 1. Waste Number � <br /> S State <br /> .K G a Oil ' EPA/Other <br /> ,� i <br /> N b' <br /> E }}gg State <br /> O <br /> 000 E <br /> / g EPA/ptber <br /> v A t at't <br /> o T c state <br /> 80 0 <br /> R I HIS WASTE STREAM HAS 6 EN QUALIFIED R EPA/Other n <br /> r. <br /> FOR RECYCLING/ — <br /> State <br /> LU <br /> Z. <br /> U!K ENVIRONMENTAL FACILITY IN LOS ANGE1. <br /> �;i`,I ,;;?SNI'',.CHIS FACILITY A T E NE ES <br /> EPA/Other <br /> W <br /> Z J. Additional Descriptions for Materials Listed Above t14i1( { 'g Codes for Wastes Listed Above <br /> w <br /> QE1R EPA NUMISE IS CA 08003b. <br /> 0 15. Special Handling I structions and Acldit nal Information p <br /> Z .ate :' � , zea S ex /i may) : o <br /> kl A a bi f fes+ <br /> W G 7 ` <br /> CES e f ,m <br /> 16. GENERATOR'S CERTIFICATION: I here6y declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, I <br /> Umarked,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 econically' <br /> practicable and that I have selected the"practicable method of treatment,storage,or disposal currently available to me which in the present and future threat to humanomhealth <br /> v' 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 waste management method that is <br /> Oavailable to me and that I can afford. <br /> }. Printed/Typed Name Signatu Month Day Year <br /> V _, 3 <br /> Z AA 1PA11. oil 101i; <br /> w T 17.—Tr nsorter 1 Acknowledgement of Rece, t of Materials <br /> R <br /> w A Printed/Typed Name SignatureN 6 bl� 4/44c, °""" Ij'f.` Month Day YearUj 1 <br /> P <br /> LL- 0 18. Transporter 2 Ackgowledgement of Receipt 4f Materials <br /> TPrinted/Typed N ,ra / Signature '`� Month Day � Year i <br /> LU E f f . <br /> R cC a-� l �' j/Lr� CA I <br /> f / <br /> V 19. Discrep ncy Indication Space <br /> Z F <br /> — A <br /> L <br /> 120. FarjJ4Y O ner or Operator Certification of receipt of hazardous materials covered by this manifest "ce as not ,in'Itim'19, <br /> T Prinfe /Tyed ame ` < ) Signature '* 1 n h„, /Ray,") f r Q <br /> _ __ <br /> DO NOT WRITE BELOW THIS LINE. {- <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> (1/99) (Generotors who submit hazardous waste for transport out-of-state <br /> DTSC 8022A , j <br /> EPA 87022A produce completed copy of this copy and send to DTSC within.30 days.) <br />