Laserfiche WebLink
Pr <br /> State of California—Environmental Protection Agency 185-01 <br /> For%,Approved QMB No.-2050-0039(Expires 9.30.99) See Instructions on back of a 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(72-pitch)Miter. IN Sacramento,California <br /> UNIFORM HAZARDOUS <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST CAL 0001 13294 95046 of 1 is not required by Federal law. <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number S <br /> 1262 LATHROP RD `,Jj <br /> O MANTECA CA 95336 B. State Generator's ID <br /> to <br /> to 4. Generator's Phone (209) 823-8717 <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> LO <br /> 00 <br /> 6 SAFETY—KLEEN SYSTEMS, INC I D 9 49 8 02 D. Transporter's Phone <br /> 0 800 669-5740 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> a SAFETY—KLEEN (TO) INC. SCR 000074591 F. Transporter's Phone <br /> U e F i i an s 10. US EPA ID Number G. State Facility's I <br /> adA`01n°V k �� 1IS, INC C O 0 8 1 <br /> g 6000 88TH STREET <br /> Z SACRAMENTO CA 95828 CAO 000084517 H. Facility's Phone <br /> _o <br /> u. 1 1 1 1 1 1 1 1 1 1 1 916 386-4913 <br /> J 12. Containers 13. Total 14. Unit <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> U No. Type Quantity Wt/Vol I. Waste Number <br /> z a State <br /> WASTE TETRACHLOROETHYLENE, 6. 1 UN1897 DF P 741 <br /> 3 G PGI I I RQ(10 LBS) (ERG# 60) 13 LBS/G L EPA/Other <br /> (FO02, DO07, DO39, DO40) a Q F002 <br /> OE As yaaEx <br /> N b. State <br /> 60 <br /> 65 E <br /> R EPA/Other <br /> A C. State <br /> 6 T <br /> w O <br /> R EPA/Other <br /> 6c <br /> w d. State <br /> F <br /> Z <br /> U EPA/Other <br /> w <br /> V) j,(Addiiionc6�s�,[ijonZfg 5(Vrials L}ted[aboy,�O4® K. Handling Codes for Wastes Listed Above <br /> CL j A) VJ DCPd`i► CA) Li 0. 14 01 b <br /> V) <br /> LU <br /> i C. d. <br /> J <br /> Q <br /> Z 987635669 000209 10 06 <br /> O 0013 046 0000831r, <br /> 61 9G# �90ad8d®a49923760 24HR <br /> a SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIER, AS NECESSARY. <br /> Z <br /> = A: 12627 B: C: D: <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,packed, <br /> Vmarked,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 toxi ty of wast enerated to the degree I have determined to be economically <br /> N <br /> practicable and that I have selected the racticable method of treatment,storage,or disposal currently ailable to which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a sma I quantity generator,I have made a good faith effort to mini ze m to/ <br /> generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> 0 <br /> >- Printed/Typed Name ` Signature Month Day Year <br /> Z 14 /A 0 1.3 3 1 to lo <br /> w T17. Transporter 1 Acknowled a nt f Receipt of Materials <br /> A Pr a Si afore Month Day Year <br /> LU R <br /> LU SI/) <br /> u- 0 18. Trans orter Acknowled a ent <br /> O R o Recei t of Materials <br /> Printed/Typed ed Name Si nature Month Da Year <br /> T YP 9 Y <br /> N E <br /> R <br /> U 19. Discrepancy Indication Space <br /> F <br /> Z <br /> — A <br /> C <br /> I <br /> L <br /> 120 Facility 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 /> "Villa TSDF SENDS THIS COPY TO DTSC wVITHIN 30 DAYS. <br /> To- P_O. Box 3000, Sacramento, CA 95812 <br />