Laserfiche WebLink
State of CalRomic—Environmental Prateclinn Agency <br /> 'orm Appro"d OMS No.2050-00.39(6pires 9-30-961 See Instructions on 6*ck e 6, Department of Tolk Substances Con, <br /> )t00"Pr,"t 01 type. Form designed for use an elite{12-pach}� rfter, Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No, Manifest Document No. 7. Page I I Information in the shaded areas <br /> WASTE MANIFEST is not required by Federal tow, <br /> 3. Generator's Name and Mailing Address <br /> 10i <br /> 1N wow, <br /> kV <br /> Aft, 1-::",UWI,1W, <br /> 4. Generator's Phone -.1z <br /> 5. Transporter I Company Name 6. US EPA ID Number <br /> 0? <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> J <br /> 9. Designated Facility Name and Site Addreu 10. US EPA ID Number <br /> -,CA <br /> 4 <br /> w <br /> 3, <br /> F <br /> I N -r Y <br /> R <br /> 11. US DOT Description(ioclucling Proper%ippiN Name,Hazard Class,and ID Number) 12. Containers 13. Total lk Unit <br /> No. I Type Quantity WI/Vol <br /> G E <br /> L <br /> N b. <br /> E <br /> & <br /> 2�k <br /> L <br /> � k <br /> %� <br /> LL-- <br /> d. <br /> !T 0$ <br /> I5. Special Handling Instnrc#ians and Additional Information - - <br /> 7 <br /> V.- <br /> < <br /> Z <br /> 3 �ftfii L: <br /> f. <br /> 16. GENERATOWS CMT94CATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping norm and are classified, <br /> 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 /> tf t am a large quantity generator, I certify that I have a program in place to reduce the volume oDd toxicity of waste generated to the degree I have determined to be <br /> =economically practicable and that I have selected the Practicable method Of treatment,storage,or disposal currenti/available to me which minimizes the present and future <br /> et to human health and the environment;OR,if I am a small quantily generator, i have mode a good faith effort to minimize my waste generation and select the best <br /> CK waste ma merit method that is available to me and that I can afford. <br /> Primed/Typed Namelignalure nth Day Year <br /> 1' e"t;f ft -of-'a"Feria" <br /> LU <br /> APrintod/Typecl Name <br /> Month Day Year <br /> a 18'.'Trat!p2nr 2 Ackn&.redqemere of Receipt gkfiAate,ials <br /> 6L 1 Printed/Typed Name Signature <br /> .0 month Day Year <br /> R <br /> 19. Discrepancy Indication Space <br /> Is <br /> .7 A <br /> C, <br /> L <br /> 1 20, Facility Owner or Operator Certification of receipt of hazardous materials covered this manifest except as noted in item 19- <br /> T Printed/Typed Name Signature <br /> Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> -T-C 8022A (1/95) <br /> . 8700-22 el6wt GENERATOR RETAINS <br />