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Tonic Substances Control Division <br /> of <br /> orlf eolld a/lf 9(Expires 9-30-91) Sacramento,California <br /> I' <br /> de III for use on elite(12- riteQ. <br /> as prir• 7 O US EPA ID No. Manifest information in the shaded areas <br /> `• 1 .tA HAZARDOUS ocament No. of la not required by Federal law. <br /> ATE MANIFEST A. Siete Manifest Document Number <br /> r ,or'e Name and Mailing Address 81,3431031 <br /> .;0. DELTA a <br /> B. Slate Generator's ID <br /> 65, N. _CARLTON AVENUE <br /> &'%Q1;*!111PA (CA. 95203 <br /> If <br /> g, US EPA ID Number C. Siete Trane Doer a ID 1 C <br /> 5. Transporter 1 Company Name 3 9 8 6 7 1 $ D. Trensporter's Phone <br /> • S, US EPA ID Number <br /> MANAG E. Slate Transporter'&ID <br /> 7. Transporter 2 Company Name F. Transporter's Phone <br /> JG. State Facility's ID <br /> - 1p, U3 EPA ID Number <br /> 9. Designated Facility Name and Site Address <br /> a <br /> CHEMICAL WASTE MANAGEMENT H. Facility's Phone ` <br /> � '15251 OLD SKYLINE ROAD 7 209 386-9711 <br /> a a 12. Containers 73. T ant int 1' <br /> _ Quantity Unit Weate No. <br /> No. Type WI/Vo1 <br /> –{ O 11. US DOT Description(Including Proper Shipping Name,Hazard Claes,end 10 Number state <br /> J <br /> U e. , <br /> WIiSTE FLPaMLE LIQUID N.O.S. FLAMAHLE <br /> EPA/ he <br /> Z 2750#s : .5 /7 <br /> � E LIQUID UN 2993 (F005) — State <br /> 3' N ,... <br /> E b. EPAI OIher <br /> LESS THAN 30 GAL O 2 W <br /> 6i R HAZARDOUS WASTE SOLID, N.O.S. ORM—E, NA 91$1285Ms . •q t,' 7 <br /> T' (EMPTY CRUSHED CONTAINERS — sere <br /> v O <br /> v R c. EPA/Other <br /> •� State <br /> W d...`� EPA/Other <br /> F, <br /> W <br /> U K. Handling Codes lar Wastes listed Above <br /> W J. Additional Descriptions for Materials Listed Above a. - b' <br /> Z99 <br /> m A) PROFZE $g0a623SF0 c. d. <br /> " B) PROFILE $G16634SF0 <br /> J <br /> a <br /> O <br /> � 15. Special Handling Instructions end Additional Information <br /> 2 <br /> w GLOVES, GOGGLES, AVOID SKIN CONTACT <br /> J <br /> a 18. <br /> V y applicable international end <br /> GENERATOR'S CEpacked,marked.and labeled.declare <br /> and hare n oil respects In 1proper B1condition tot trlansport by highwayaaccordin scribed above <br /> a p proper shipping name <br /> J <br /> and <br /> are classified,p <br /> y national government regulations. n in <br /> W 111 em a large q y p storage,or disposal currently available to me which minimizes the <br /> quantity generator.I certify that I have a propre ecliceble method of treatment end toxicity of waste generated to the degree I have determine <br /> 0 to be economically practicable and Ihel I have selected the p quantity <br /> 0 <br /> generat and future threat tion end select the best al wa health <br /> mana and <br /> the environment; <br /> that OR.eveilebI,Io mall and that Igcan afford.have made a good faith effort to minimize my waste <br /> Month Day Year <br /> Signature ` <br /> CZW7 Printed/Typed Name <br /> fT 17. Transporter 1 Acknowledgement of Receipt of Materiels Month Day Year <br /> ZR Slgnetur9y. <br /> a A Printed/Typed Name C <br /> 11- N <br /> S L <br /> P 18. Transporter 2 Ack o•,tlledgeme <br /> O nt of Receipt of aterials Month Day Year <br /> W 0 Signature <br /> WR Punted/Typed Name <br /> U T <br /> E <br /> Z_ <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> I C <br /> L Year <br /> 1 20. Facility Owner or operator Certification of receipt of hazardous materials covered by this manifest except es noted in Item 1 Month Day <br /> T ti. Signature <br /> y Printed/Typed Name <br /> DHS 8022 A(1/88) Do Not Write Below This Line <br /> EPA 8700-22 <br /> (Rev.9.88)Previous editions are obsolte. YELLOW: GENERATOR RETAINS <br />