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State of Colifomic--Environmental Protection Agency <br />Farm Approved OMB No. 2050-4039 (.Expires 9-30-94) See Instructions on back of �. Department of Toxic Substances Control <br />;lease print !r type. Form designed for vse on elite f 1 .. <br />2pfrch) rySacramento, California <br />a <br />Lr, <br />in <br />r. <br />C4 <br />u -t <br />00 <br />CD <br />ao <br />DT5C 8022A (12/91) <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS LINE. <br />Blue: GENERATOR SENDS !HIS COPY TO DTSC WITHIN 30 DAYS. <br />"a: P.O- Box 400, Sacramento, CA 95812-1400 <br />I. Generator's US EPA ID No. Manifest Document No. <br />2. Page I <br />Information in the shaded areas <br />UNIFORM HAZARDOUS <br />is not required by Federal law. <br />WASTE MANIFEST <br />CI AlDI 01 019t 11 8191 Q 6191 61 2 9 0 51 <br />of 1 <br />3. Generator's Name and Mailing Address <br />A. State Manifest Document Number <br />EP CHEMICAL INC. <br />n 90 <br />3437 SOUTH AIRPORT WAY, STOCKTON, CA 95206 <br />S. State Generators ID <br />4. Crenerator's Phone �.129j <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporters ID y <br />Q2 a <br />c/ <br />c 0 a6z T <br />D. Transporter's Phone S- _ �r 1 1/ <br />✓ 0 <br />w.7 <br />7, Transporter 2 Company Name 8, US EPA ID Number <br />E. State Transporter's ID <br />F. Transporters Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility s ID <br />NORRIS ENVIRONMENTAL SERVICES <br />I <br />5215 SOUTH �$ BOYLE AVE. <br />H. Facility's Phone <br />LOS ANGELES, CA 90058 <br />c 111 0 1 9� 71 01 31 01 91 91 3 <br />111589-7 11 <br />11. U5 DOT Description {including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantify <br />14. Unit <br />Wt Vol <br />i, Waste Number - <br />No. <br />T <br />a`RQ, <br />$ <br />WASTE CORROSIVE LIQUID, N.O.S. (SULFURIC <br />ACID) CORROSIVE MATERIAL, <br />C? <br />EPA/Other <br />UN1760 OM, E G,,160) <br />T T <br />G <br />E <br />N <br />b, a . <br />State <br />E <br />EPA/Other <br />R <br />A <br />T <br />C. <br />State <br />0 <br />EPA/Other, <br />R <br />d. <br />stare <br />EPA/Other <br />J,. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes <br />Listed Above . <br />a. WATER 60-722, SULFURIC ACID 22--30%, SODIUM DICHROMATE-- <br />b. <br />6-10%. <br />C. <br />d. <br />15. Special Handling Instructions and Additional Information <br />a. E1065300002CR 24 HOUR EMERGENCY CONTACT: (209)982-0160. <br />WEAR APPROPRIATE PROTECTIVE GEAR WHEN HAtSIDLING. <br />PLEASE INVOICE CJSTO11ER #E08271. <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br />packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable federal, state and international laws. <br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume and 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 currently available to me which minimizes the present and future <br />threat to human health 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 <br />waste management method that is available to me and that I can afford. <br />Printed/Typed Nome Signature <br />1 <br />Month Day Year <br />Lar.t K . KtiT rn! <br />017- <br />T <br />_ <br />17. Trans orter 1 Acknowledgement of Receipt of Materials11 <br />rs <br />Printed/Typed N <br />Signature Month }Day Year <br />1712 17 <br />r <br />O <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in item 19. <br />T <br />printed/Typed Nome <br />Signature '� Month Day Year <br />Y <br />DT5C 8022A (12/91) <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS LINE. <br />Blue: GENERATOR SENDS !HIS COPY TO DTSC WITHIN 30 DAYS. <br />"a: P.O- Box 400, Sacramento, CA 95812-1400 <br />