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(State of California--Health and Welfare Agency Department es Health Services <br /> Form Approved OMB No.2050--0039(Expires 9-30-9 Toxic Substances Control Division <br /> � �f Sacramento,California <br /> PleasayzyoWilype. (Form designed for use on elite r fypewrifer).�t 'I 7 i 9: <br /> 1. Generator',US PAID No. Manifest 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS Document No. <br /> WASTE MANIFEST of a not required by Federal law. <br /> 3. Generator's Name and Mailing Address 00 8 I A. State Manifest Document Number <br /> 90083812 <br /> ASCO DELTA 705 NORIA CARLTON AVENOS <br /> 8. State Generator ID <br /> SPOCRTON, CALIIaORNIA 95203 <br /> 4. Generator's Phone( 04 _ <br /> n 5. Transporter 1 Company Name 8. US EPA ID Number C. State Transporter's ID <br /> n D. Transporters Phone 4 <br /> M1 <br /> N <br /> 'p 7. Transporter 2 Company Name 9. US EPA ID Number E. State Transporter'.ID <br /> m F. Tran,porter's Phone <br /> 8 <br /> 10. US EPA ID Number G. State Facility's ID <br /> 9. D�esiggnaatte7dd FFacil�ityy Nam. <br /> and Site Address <br /> MIT <br /> CHEXI <br /> AII <br /> 0 35251 OLD MMLINE ROAD H. acillry'e P ono <br /> C44 a gETTLM7AN CITY, CA 93239 <br /> IG 1A T 1 1910166141,65 11- t— <br /> ell ¢ 12. Containers 13. Total 14. 1. <br /> M 11. US DOT Description(Including Proper Shipping Name,Hazard Class,antl 10 Number) Quantity Unit Waste No. <br /> W No. Type Wt/Vol <br /> M state <br /> 461 <br /> Cz G ,WASTE ELAHABLZ LIQUID N.O.S. FLAHASLE t r,'"" EPA/Other <br /> E LIQUID ON 1993 (FOOS) C% TF!Ooq <br /> C 3 N Stale <br /> iv R ,NON SOLID f1ASTE HAZAR 13 NASTB 80L , <br /> m r N. .S. ORMB t3A9189 (CRD EMPTY CONTAINERS EPA/, <br /> a 0 SI to <br /> a R C. <br /> EPA/Other <br /> a <br /> Wd State <br /> Z EPA/Other <br /> U <br /> W K. Handling Codes far Wastes Listed Above <br /> 0 J. Additional Descriptions for Materials Listed Above <br /> 0 A PROFILE # B02623SP0 a b <br /> 03 <br /> w <br /> C. d. <br /> _ ¢ 3 <br /> Q <br /> Z <br /> 0 <br /> F 15. Special Handling Instructions and Additional Information <br /> w 1-800-742-1671 24 AR P.MIERGEWT NpDIIBER <br /> J <br /> U <br /> 18. <br /> GENERATOR'S CERTIFICATION: I hereat'declare that the contents of this consignment are fully and accurately described above byproper shipping name <br /> � <br /> 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 /> d national government regulations. <br /> N <br /> 0 t I is a large quantity generator,I chatty that I have a program in place to hodreduceof the volume and toxicity of os ate generated to the degree 1 have determine <br /> U pr be economically practicable and that have selected the practicable method of treatment,storage,or have <br /> disposal ca entlygood available to me which minimus, the <br /> Y present and future three)to human health and the environment;OR,if I am a smell quantity peneretor.I have made a hood faith effort to minimize my waste <br /> U generation and select the beat waste management method that is available to me and that I can afford. <br /> 11 <br /> W Printed/Typed Name Signet MOnfM1 Day Year <br /> 7 / ) ' <br /> W ALAN <br /> T E t20 U e IL— <br /> at T 17. Transporter 1 Acknowledgement Re eipt of M erials /' <br /> R <br /> Z _ Signa Month Day Year <br /> Z A Printed/Typed Name <br /> P <br /> W 9. ransporter 2 Acknowlatlgemen[of Recaipl bf Materials <br /> W O Month Day Year <br /> W RPrinted/Typed Name Signature <br /> T <br /> Q <br /> U E <br /> Z <br /> 19, Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> ' I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except 0a acted in Kem 19. <br /> TSigns r Month Day Year <br /> y Printed/Typed Nem <br /> �atl�2ez C14, <br /> DHS 8022 A(1/88) Do Not Write Belo is Line <br /> EPA 8700-22 <br /> (Rev.9.88)Previous editlona are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />