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•1l\1\Y-as,aleAlVAR. X% •a �" a VV <br /> \., <br /> w... +�. ......��r-..�; <br /> Slate o��el,' rnle,--Health and Welfare Agency <br /> F .,n A� rov d,OMB No.g05P.W39(Expires 9-30-91) Department of Health Services <br /> Please print Or type. (Form designed/or use on stile 02-ptfch typewriter). Toxic Substances Control Division <br /> Sacramento.California <br /> NIM <br /> HAZARDOUS 1. Generator's US EPA IO No. Manifest z. Page 1 <br /> WMANIFEST Document No. Information in the shaded areas <br /> 1 3 4 7 6 (3 0l snot required by Federal law. <br /> FI3. Oeneraa erM Mailing Atltlreas <br /> A. Stele Manliest D�cuplep(Nam(ler� <br /> ASCO/DELTA 8 4 31�(/T <br /> 705 IT. CARLTON AVE. , STOCKTON, CA 95203 B. State Generator's ID <br /> 4. Generator's Phone(209) 941^$111 <br /> 6.-Transporter 1 Company Neme e. US EPA ID Number 3 6 0 1 7 1 0 i <br /> r C. State TrenaDorter's 10 ! 1(.:-.� <br /> d CHEMICAL WASTE MANAGEMENT IC I Ali) <br /> LQJ9 8 D. Trenaponer'e Poona <br /> m 7. Trensponer 2 Company Name ^ <br /> B. US EPA ID Number E. Stale Transporter's ID 57 <br /> 0 <br /> m L—JF. Trenaporter'e Pnone <br /> 9.i Designated Facility Name and Site Address 10. US EPA ID Number3 <br /> J <br /> CHEMICAL WASTE MANAGEMENT G. slateFacnuyslD <br /> v 35251 OLD SKYLINE ROAD A 6 4 1 7 <br /> Z <br /> KETTLEMAN CITY, CA 93239 H• Facility's Phase <br /> M A T 0 0 4 6 } <br /> 1 a�� ) 3 �� i7 ,i � <br /> u 11. US DOT Description(Including Proper Shipping Name.Hazard Cleea,end ID Number) it Containers 13. Total 14. I, <br /> OuentitY Unil 1.Waste No. <br /> V No. Type WI/Val <br /> e. <br /> Z WASTE FLAMABLE LIQUID, N.Q S. PLA BL Stats 461 <br /> NLIQUID UN 2993 (DO01 , F005) til t)U her A' ner i+ C <br /> E It, WASTE SOLID N, O D 0 g 3.A 'G B0Sq ^ F005 ^ <br /> R a O.S. , ORM—E, State <br /> 00 S T NA9189 (EMPTY CRUSHED CONTAIN$RS LE$$ 513 <br /> < o THAN oo Eli 0 0 W 0 3 7 9 EPA/OIN/% <br /> N R c, <br /> —� Stats' .I <br /> EPA/Omer <br /> 1- d. <br /> 1- <br /> Z W <br /> Slate <br /> V <br /> w EPA/Other <br /> Z J. Additional Descriptions lur Materiels Listed Above <br /> 0- A). PROFILE #t02623SPO K. Handling codes for Wastes Listed Above <br /> a. b. <br /> W <br /> B) PROFILE IIG16634SFO <br /> J C. d. <br /> Z <br /> Z <br /> O ' <br /> r <br /> 18. Special Handling Instructions and Additional Information <br /> WZ <br /> CLOVES, GOGGLES , AVOID SKIN CONTACT <br /> J <br /> Q <br /> V 18. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by Proper shipping name <br /> NJ 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 /> national government regulations. <br /> cc If I em a large quantity generator,1 cenity,that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> O to be economically practicable and that I heve selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> present and future 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 weals <br /> V generation and select the best waste management method that is available to me and that I Oen aflord. <br /> Z <br /> m Printed/Typed Neme <br /> ¢. <br /> Shirture _ 4}.r - Mgn Dboyl- Year <br /> -.�.f.�,, -r- / <br /> W111 ALAN T. ESTF,S ..), <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials Ir 9 <br /> G R <br /> A Printed/Typed Name1 SI ds ure n <br /> u. N tl. I - / f�- MonrA OeY iYeer <br /> P <br /> 18. Transporter.. Acknowledgeme of Receipt of Materials Lt( <br /> W <br /> Q T Printed/Typed Name S store ') <br /> E Month ;Day Year <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> L <br /> I20. Facility Owner or Operator Cenificetion of receipt of haardous materiels covered by this manliest azcept ea noted in Item 19. <br /> T z <br /> y Printed/Typetl Neme Signature <br /> Month Day Year <br /> S 9722 A /ae) <br /> A 670p-22 Do Not Write Below This Line <br /> ev.9-88)Previous editions are obsolete. <br />