Laserfiche WebLink
o,• a or�oororma—cnvrronmenrat rrorecnon Agency <br /> r m Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of -3e 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite 112-pirch) iter. Sacramento,California <br /> UNIFORM HAZARDOUS I. Generator's US EPA ID No, Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST O V 5 01 <br /> D /�\ '\ I is not required by Federal low. <br /> V v U of <br /> 3. Generator's Names and Moiling Address iA+State o i est Documen Num6eE. <br /> C <br /> FSP West Coast Products LT.G <br /> Lr) P.O.Box 90$377 <br /> to A. Generator's Phone (310 787-4600 Los An teles,GA 90009 M- <br /> f\ <br /> t T <br /> lV 5. Transporter 1 Company Nome 6. U$EPA ID Number <br /> O ., <br /> 1 P 7 7r P s7 C rut a Tn 9 $ <br /> _ 7. Transporter 2 Company Name 8. US EPA ID Number <br /> VJ r <br /> :3.Q - s Phu s u'�4 r ~ <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number u .' ?��j�' ' z�'tq Ysf171, <br /> 37 g DeMenno Kerdoon - Z <br /> 10 0 2000 North Alameda Street r '-� a �r <br /> Compton,GA 90222 1 3 5 2 <br /> Q 12. Containers 13- Total `- <br /> V U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) - <br /> Z No. Type Quantity Wt/Vol <br /> a f> rite__um e <br /> Gasoline Mixture Stats <br /> `= 3 UNI 203 P.G.11 <br /> G D i G `E QII e:- <br /> C�iE t aced as a RCRA Waste <br /> N b.00 <br /> Stagg.. <br /> ao Ear <br /> v R <br /> C14 A <br /> o T bra <br /> cc) O <br /> R 'Eetb e s <br /> Uf <br /> Z d' <br /> M <br /> w - r. <br /> V fit' fCtthee7�' '- <br /> w <br /> t o' -Desii•"'"�'" a`t¢P'" t �6"o�r .'"cl i 'Co�"s'"kQnstet.Ersted hove���-�4"'� -"�"� <br /> LU rs <br /> Q <br /> Z <br /> O 15. Special Handling Instructions and Additional information <br /> Fo o- <br /> Z appy priate pr thing ARCO 4932 BESI# 38374 <br /> Q Gasoline and Water miuure. Wear o ) otective rlo 16 East Aardinti WayMaiF <br /> LU (949)753-5826(24 hourEmergencjPhone , <br /> (949)450-1010(Mon-Fri lam to 5=) Stockton,GA <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 /> V marked,and labeled,and are in oil respects in proper condition for transport by highway according to applicable international and notional government regulations. <br /> J ' <br /> -' If I am a large quantity generator,1 certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> a- practicable and that l have selected the practica6le method of treatment,storage,or disposal currently available to me which minimizes the present and Future threat to human health <br /> 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 /> la� available to me and that I can afford. <br /> O <br /> UPrinted/Typed Name Signature o Da e <br /> ZLary' MOothart/BF.SI as tint of&CO <br /> (� k 17. Trans otter 1 A owied ement of i t of 14aterials <br /> wA Printed/T a r nature <br /> ::ENS <br /> 9 r Da <br /> w fr/ r <br /> P <br /> tt- 0 1 Tans otter 2 Acknowl ement of Receipt o Materials <br /> 0 RPrinted/T ed Name <br /> LU T Printed/Typed Signature Month Day Year <br /> V) E <br /> _< R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> — C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of recei 1 of hazardous materials covered b this ce t as noted in Item 19. <br /> T Printed/Ty ^ Signature Month, Day Yeor <br /> DO NOT WRITE B W THIS LINE. <br /> DISC 8022A(1/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />