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• State of California—Environmental Protection Agency <br />_ s Form Approved OMB No. 2056-41039 (Expires 9-3496) See Instructions on back Of6. Departmem of Toxic Substances— <br />prim or type. Form designed for use an elite (12-pitch)r seer. Sacramento, Calitomia <br />C <br />Lr <br />,r <br />n <br />tr <br />DO NOT WRITE BELOW THIYLINE. <br />'eilow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />DISC 8022A (1/95) {Generators who Submit hazardous waste for transport out-of-state, <br />EPA 8700-22 produce completed copy of this copy and send !a DTSC within 30 days.) <br />UNIFORM-HAZARiDOUS <br />1. Generator's US EPA IQ Na. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />W <br />' WASTE MANIFEST <br />C D 1 1 9 18 9 1 fi 4 <br />9 c+ <br />a+ <br />is not required 6y Federal taw. <br />3.,?U r}hgrp j jMg', INC <br />i{ <br />A. S1aM Marufast Document Number [� n <br />95503S4S <br />R,0. 80I 6189 <br />MMTQAI, CA 95216 <br />8. ,state Cxrseratars FO <br />A. Garbratar's Phan. ( 219-}983-3339 Contacts LOU KITAGAKA <br />5 <br />S, Transporter I Company Name 6. US EPA ID Number <br />C_ Sktte Transporterrs id <br />RINIC ANTIRIM11TAL INCH., <br />J R <br />D. Transporfer's f+harte <br />D i 1 91 4 5 12 16 <br />5' 7 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporlers IT) <br />i F. Transporters Rkxw <br />9. Designated Facility Nome and Site Address 10. US EPA ID Number <br />G. SFatt t' <br />{° <br />RMIC aTIR0U11 ITdL Il e, <br />2481 Bay seed <br />K Focrgtlfs Pharst <br />haat Palo Wo, CA 94313-1316 1 C11 ID 10 1 1 19 j 415 12 16 <br />15 7= <br />J+ Xs)- 324-1633 <br />11. US DOT Descri n (includingProper Shipping Name, Hazard Class, and ID Number)12. <br />rope pp gNo. <br />Corttainen <br />13. Total <br />Quantity <br />ld. Unit <br />Wt/Voi <br />I. Waste Number <br />Type <br />� <br />it to C8d0AIC ACID SOLOTI{{ibll <br />6 81I755 PGTT <br />_ <br />Stab <br />EpSifler <br />N <br />b. <br />State <br />E' <br />EPA/Other <br />R <br />A <br />T <br />c. <br />_ <br />state <br />O <br />EPA /01her <br />R <br />d, <br />state <br />EPA/01her <br />J. A&bk q Descriptions for Ma is iols Elated Ab6ire <br />Kan d6ny CodRe Tier Wastes listed Above <br />C.d <br />,sItNee"I Hon1-rVr,slruec!lpnn ondl�dj9tallrtfo s! 'abler Mote CDde(s)' <br />�j� � <br />l3�1111667115 i <br />24 OR. MRGINCY RIM91 MR, <br />11-A fit D117 <br />Fd. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping none and ore classified, <br />packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations. <br />It I am a large wo" generator, I 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 <br />economicaiiy prochcobia and that 1 have selected tiro practicable method of treatment, storage, or disposal currently available to me which minimizes rise present and suture <br />threat to human health and the a tironrnesd; OR, if I am a small quantity generator, I have mode a <br />good faith effort to minimize my waste generation and select the best <br />wash management method that is available to me and that I can afford. <br />Printed/Typed Name <br />L 0 W, k'rri4 QA, VOt- <br />Sigrwture <br />7' <br />Month Day Year <br />1?6 •- <br />17 Transporter 1 Ackintowledgerment of Receipt of Materials_ n . <br />- <br />3 <br />P /T� V <br />S ` l�'� !ro s <br />,�,t, jam" ' <br />ar"I" Day Year <br />0 <br />18. Trarisporter 2 Acknowledgement of Receiiiat of Materials <br />I <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />19, Discrepancy Indication Spcsce <br />F <br />A <br />C <br />I <br />t <br />1 <br />20Fo<4ity Owner or rotor Certification of recei t of hazardous materials covered this manifesl ezce t as noted in Item_ 19. <br />T <br />Y <br />Printed/Typed Name <br />Sigrwture <br />Mo,kh Day Year <br />DO NOT WRITE BELOW THIYLINE. <br />'eilow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />DISC 8022A (1/95) {Generators who Submit hazardous waste for transport out-of-state, <br />EPA 8700-22 produce completed copy of this copy and send !a DTSC within 30 days.) <br />