Laserfiche WebLink
Sime a:�0iiiamla—Fwfranmenml Praieaioa Sgen<y <br /> - :.:B r+a .^'D-003"IE=vire„-,o-9;1 See lrrstructiar's an back a�¢e 6. Department ai Toxic Substance,Can,ra <br /> F e�ase^p�nt or type Form devgnea for use on slue 112 pFch`pawras, - Sacramento,California <br /> ` I I Generator's US EPA ID No Manifest Document No 2. Page tI lil^orm 1 n the shaded areas <br /> s[IEF� UNIFORM HAZARDOUS cl by Fedn ai law. <br /> WASTE MANIFEST asw °f <br /> ener t r s ha ne AaoGng Ad.ess .4. Slate Ma assn D N 6 <br /> G <br /> O <br /> B. Stale Generator's ID <br /> sn d. <br /> Genera./s Phone <br /> t 's ID[Reserved:) <br /> N5 Transporler l Company Name 6. US EPA ID Number C.Stole Trans purer <br /> D. Transporters Phone <br /> °? 7. Transporter 2 Company Name B. US EPA ID Number E State Tronsporter's ID[Reierved.1 <br /> F. Transporter i Phone <br /> V 9, De9g ted F.,,ht,,.N.bnb,ord Site Add dse ..tl 10. US EPA ID Number G. Stale Facility's ID <br /> Q y H. Facility's Phone <br /> iO <br /> '.`412. Containers 13. Total Id. Unit <br /> V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and 10 Number) _ No. Type Quantity Wt/Vol I Waste Number <br /> Slate .. <br /> ~ ..jam qs F.}-rr Y r' #yi:"1 ,xf3 Y-./' ! i_._ ..t �y EPA/Oche <br /> b Stole <br /> o N ...b, <br /> m E EPA/Olher <br /> e R <br /> IN <br /> A <br /> m <br /> o T <br /> mO EP <br /> Ot <br /> R A . <br /> w State <br /> d. . - <br /> Z EPA/Other. .. <br /> Z <br /> V <br /> w - - <br /> K. Handling Codes for Wastes listed Above - <br /> ZJ. Additional D sc�tions for Materials Listed Above - - <br /> d <br /> N <br /> w d_ <br /> Q <br /> OZ }S.,Spec qhH ndlin�In;IFs{gtianse�rsedditional Information <br /> ,.._, r -t_ t l ._,,. <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,pocked, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable interactional and national governmem regulotiom. <br /> V <br /> J If I am a longe quantity generator, certify thatl have a pregnom in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> a pracricable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat he human health <br /> r� and the environment;OR,if I am a small quantity,generator,I have made a good faith effort la+ninimize_my waste generation and select the best waste management method that is <br /> W available to me and that I can afford. .� t `. <br /> O t <br /> Si n tare ry;, s j Nonni- Day Year <br /> U Prin /Typed Na; 9 ° isms � ) CI LL <br /> Z -- <br /> C) 1 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> Month <br /> A - Mdt DayvS Ywr. <br /> Prinyped N m . Sign. <br /> l <br /> f s R `lf 01e <br /> w _ <br /> 0 b 18. Trans rter 2 Acknowlodgement of Receipt of Materials <br /> O R Printed/Typed Name Signatory Month Day Year <br /> T <br /> w E <br /> h g <br /> V19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or O em or Certification of receipt of hazardous materials covered b this manifest exce t as noted in Item 19. <br /> j Printed/Typed Name Signature Month Day Year <br /> Y I �—r� I_ <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A 11/991 To: P.O.Box ADD, Sacramento, CA 95812-0400 <br /> EPA 8700-22 <br />