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ces <br /> Stale of California—Health and Welfare Agency Department Health vi <br /> �*vIn )(b 7�8 Ivfft No.2070-0039(Expires 9-30.91) Toxid Substances <br /> Control <br /> DDivision <br /> on <br /> �z Please print rt pg_.EFomi designed for use on alittypewriter. r r1,QI Sacramento,California <br /> t rotor's US EPA ID No. Manifest 90 1 Information in the shaded areas <br /> 7 UNIFORM HAZARDOUS <br /> MANIFEST 1 7 3 9 7 OD ca�ent 19 1, 1 1 <br /> of is not required by Federal law. <br /> _e 3. Generator's Name and Mailing Address A. State Manifest Document Number _.. <br /> ASCO DELTA 705 NORTH CARLTON AVBNRE <br /> STOClTW, CALIFORNIA 95203 B. State Generators ID <br /> 4. Generator's Phone( 209) 941-4111 ff 0 4 6 — 0 1 7 1110 19 <br /> 5. Transporter 1 Company Name 8. US EPA ID Number C. State Transporter's 10 /j'�— I LC I <br /> A <br /> ClEIM ZCAL WASTE MANAGMCM 3 8 6 7 1 8 D. Tranaporter's Phone Q (/ 1 111 <br /> N <br /> i° <br /> OR 7. Transporter 2 Company Name 8. US EPA ID Number E. Stets Trenaparter'a ID <br /> F. Traneporter's Phone <br /> m <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID // <br /> J CHEMICAL WASTE MANAGMEM C T <br /> 0 35251 03O SxYLZNE ROAD H. Facility's Phone <br /> �.� a RETTLEMAN CITY, CA 93239 0 61416 1 1 7 <br /> M 12. Containers 13. Total 16. I. <br /> Z <br /> W O t 1. US DOT Description(Including Proper Shipping Name.Hazard Class.and ID Number) Quantity Unit Waste No. <br /> LL No. Type Wt/vol <br /> MZ a State <br /> cc 6 <br /> Q = G WASTE FLAMA$LE LIQUMV N.O.S. FLRMABLE /3 EPA/Other <br /> Q 3 N <br /> LIQUID DN 1993 F005 �j <br /> E b. Stela <br /> Q R HAZARDOUS WASTE SOLID, N.O.S. COO <br /> W i NA9189 (CRUSHED EMM COM71 DMRS LESS THAN 30 GAL)0 W 0 0 0 0 1 y EPB{gNer <br /> V R c State �s <br /> 8 EPA/Other <br /> w <br /> itState <br /> wZ <br /> EPA/Other <br /> U <br /> 0 J. Additional Descriptions for Materiels Listed Above - �j K. Handling Codes for Wastes Listed Above <br /> Z <br /> A ILE PROF # 202623WO e a b. 03 <br /> R PRIOF= # G16634SF0 .. .. __ <br /> _ ,, . C d. <br /> J <br /> Z <br /> o � <br /> F d <br /> Z 15. Spacial Handling Instructions and Additional Information / .rte <br /> ( r'l <br /> N <br /> J <br /> J <br /> G 8. <br /> U <br /> GENERATOR'S CERTIFICATION: I hereby labeled. <br /> and <br /> are <br /> the contents of this per condition <br /> forfullytransport <br /> and t by highway <br /> y described above pl proper shipping name <br /> � and are classified,pecked,marked,and lebaletl,antl era in all respects in proper condition for transport by highway eccortling to applicable international and <br /> d national government regulations. <br /> y <br /> If I am a large quantify generator,I cartity that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> U to be economically practicable and that have selected the practicable method of treatment,storage.or disposal currently available to me which minimizes the <br /> Y present and 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 wsafe <br /> U generation and select the best waste management method that is available to me and that I can afford. <br /> Z _ Si afore Month Day Year <br /> w Pn / yped Name <br /> W <br /> W T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> Si �r Monthy Day <br /> Year <br /> ZA Prm Typed Name <br /> P <br /> w O 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> < R Printed/Typed Name Signature Month Day Year <br /> E <br /> Z_ <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 20. Facility Owner or Operel Codification of receipt of hazardous materials covered by(We ma eat xcept s n em 19 i <br /> T <br /> y Printed/Typed Name i/ i// ` Signature M f Qa Y r <br /> rw ez <br /> / <br /> DHS 8022 A(1/68) Do Not Write Below This Line <br /> EPA 8700-22 <br /> (Rev.9.88)Previous edition$are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />