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.State of California-Health and Welfare Agency Ta Depadment of Health Services !f <br /> .F ed OM@ No.2060--0039(Expires 9.3 R G 1' Toxic Substance°Control Division Please print print or type. (Form designed for use on elite(f2 writer). Sacramento,California <br /> ! 1. UNIFORM HAZARDOUS I. a us EPA 10 No. o �No. Information in the shaded areas <br /> WASTE MANIFEST q ^ m Is not required by Federal law. <br /> Tr <br /> 3. Generator's Name and Mailing Address A. Slate Manifest Document Number <br /> ASCO DELTA $ f <br /> 705 N CARLTON AVE., STOCKTON, CA 95203 R. State Generate.el [t <br /> 4. Generator's Phone( ) – H I AlHI QI '41 61 1 nI 11 71 11 fi 1 <br /> S. Transporter 1 Company Name S. US EPA ID Number C. State Tran°porter's ID , <br /> 1. <br /> CHEMICAL WASTE '18NAGEMENT I Cl A IJ nrT D. TrenaPorter'e Phone ff [7 C ��J <br /> N <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. Slate Tran°poser's ID tI <br /> 00 1 1 1 1 1 1 1 1 1 1 F, Transporter'°Phone r, <br /> m 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Slate Facillty'a ID 'i <br /> CHEMICAL WASTE MANAGEMENT C I Al T1 01 oi PuQyLbu I ii ii <br /> a 35251 OLD SKYLINE ROAD H. Facilhy's Phone <br /> V <br /> KETTLEMAN CITY, CA 93239 1 ClTI 01 01 A 61 41fi11 11 7 (209) 386-9711 <br /> I¢O 12. Containers 13. Total 14. 1. <br /> w 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> J <br /> No. Type Wt/vol <br /> WASTE FLAMABLE LIQUID, N.O.S. FLAMABLE state 46 <br /> Z c LIQUID UN1993 (F005 EPA/Other <br /> • R 003 D (. 1 G5 G r <br /> 3 state <br /> R b' HAZARDOUS WASTE SOLID, N.O.S. ORM—E, NA 9189 513 <br /> $ o (EF•1PTY CRUSHED CONTAINERS LESS THAN 30 GAL 12L5 <br /> )/ EPA OtNL <br /> a R c. State {1 <br /> 0 <br /> 0 <br /> m EPA/Other <br /> w d. State <br /> Z <br /> W <br /> EPA/Other <br /> Of J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> Z <br /> a. b. <br /> A) PROFILE. #E&623SFO 03 <br /> W B) PROFILE #016634SF0 C. d. <br /> Z <br /> 0 <br /> F- 16. Special Handling Instructions and Additional Information <br /> Z <br /> J <br /> O 18. <br /> J GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> J and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable International and <br /> ynational government regulations. <br /> W It I am a large quantity generator,1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> V to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> > present end future threat to human health and the environment;OR,It I am a small quantity generator.I have made a good faith effort to minimize my waste <br /> V generation end selecl the beat wsafe management method that Is available to me and that I can afford. <br /> WPrinted/Typed Name Sigrove I Monfh Day Year <br /> w ALAN T. ESTES �• B2 2�t r?�"s " <br /> W T 17. Transpoder 1 Acknowledgement of Receipt of Materials <br /> Z R <br /> A Printed/Typed Name Signature, h �� month Day Year <br /> w O 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> UT Printed/Typed Name Signature Month Day Year <br /> E <br /> Z_ <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as npled in Item 19. <br /> T <br /> y Printed/Typed No a Signature ^ Month Day Year <br /> DHS 8022 A(1/88) Do Not Write Below This line' ^� , <br /> EPA 8700-22 <br /> (Rev.9.88)Previous editions are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> r; <br />