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\ Depa(tmeel 01 HBAllll JBrV�V as <br /> of Calla- `—Health and lYellare Agency Tosic Substances Control Division <br /> Apprg� oC 9(Espirea 9 30-91) Saerememo,CeliforMa E <br /> "nm desidnec Tor use,oa elite(f2 pi( ileo. <br /> e9 prii Manifest 2. Inlormalion in the shaded areas <br /> JA HAZARDOUS Gener g s US EPA ID No o<ument No. <br /> of is not required DY Federal law. <br /> ,TE MANIFEST <br /> r A. Stele Manifest Document Number <br /> or'a Name and Mailing Address - 89431031- <br /> ;0 DELTA ; <br /> Generator's ID <br /> J5, N. CARLTON AVENUE B. Sure <br /> G��e41Gd � Re(CA. 122aii, <br /> S. US EPA ID Number C. Stale Trans6brter a ID <br /> 5. Transporter t Company Name D. Tranaponer'a Pnone <br /> MAMA(' �* C 0 3 9 fl 5 7 1 8 <br /> r 9. US EPA ID Number E. Sule Trenaponer'a ID <br /> 7. Transporter 2 Company Name F. Transporter's Plane <br /> J tg, US EPA ID Number G. State FacilitY_e ID <br /> in 9. Designated Facility Name and Silo Address <br /> m . 0 6 4 6 1 1 <br /> J CHEMICAL WASTE NANAGEMNT H. Factory,Phone <br /> a <br /> 35251 OLD SKYLINE ROAD 7 209 346-9711 <br /> Q r. 121q IC IA 111 12. Containers 13. Total la. I• <br /> Z Qua nlity Unit Waste No. <br /> ¢ <br /> O 11. US OOT Description(Including Proper Shipping Name.Hazard Class,and ID Number No. Type Wt/Val <br /> w Stale <br /> J <br /> U a , UID N.O.S. FLAMABLE EPA/Olhe <br /> Z LGn3TE FU1; 2, LIQ 2750#s 7 <br /> E LIQUID UN 299933 (FOOS) .5 Slate <br /> E b. NA 91`39 <br /> R HAZARDOUS ➢TASTE SOLID, N.O.S. ORM—E, EPA/Q}her <br /> A 1285#s o z c w 7` <br /> T ( PTY CP.USHED COITIAIITERS LESS THAN 30 GAL <br /> Slate <br /> e 0 <br /> v R- c. EPA/Other <br /> 8 \ <br /> m 'v\ State <br /> JJ EPA/other <br /> Z <br /> z <br /> w <br /> U <br /> K. Handling Codes for Wester Listed Above <br /> w b. <br /> N J. Additional Descriptions for Materials Listed Above a <br /> Z <br /> a A) PROFIE #E02623SF0 d. <br /> 0 - p. <br /> S) PROFILE #G16634SF0 <br /> Z <br /> 15. Special Handling Instructions end Atlditional Inlormetion <br /> Z2 <br /> u GLOVES, GOGGLES, AVOID SKIN CONTACT <br /> J <br /> J <br /> < 18. <br /> V contents of <br /> � ng home <br /> GENERATOR'S CERTIFICATION: I hereby led,and are inallrespects inproperconsignment <br /> on for Irlansport by highway aeccordinq to applicable ed above by riniema'nonel and <br /> J and ere classified.pecked,marked,and labeled, 1 <br /> p_ national government regulations. to the <br /> rn 1 ceed <br /> rlil that I have a program in lace to reduce the volume and toxicity <br /> tdisposalfste eneratrently available 10mewhnhvm'n melees^the <br /> 11 I em a large quantity generator. Y p p <br /> I I m a smell quantity generator.1 have made a goad faith ellon to minimize my waste <br /> O if be economically practicable r.I that I have selected the practicable method of IrealmenL storage, <br /> present and future threat to human health end the environment:OR.i <br /> > generation and select the best waste management method that is available to me end that I can eflord. Month Day Year <br /> U Sipnaluw <br /> I Printed/Typed Name l 7 7 •'r /I <br /> f� <br /> Ju T. m r c <br /> WT 17. Transporter 1 Acknowledgement of Receipt of Materiels Month Day year <br /> Z R Signal" K. <br /> A Printed/Typed Name <br /> w S L� ./ L• i <br /> O PIS. Trenspbrter 2 Acknowledgement of Receipt of Materiels Year <br /> w 0 SignatureMonth Dey <br /> W R <br /> < T Printed/Typed Name 1 <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 Certilicatlan of receipt of hazardous materials covered by this manliest except es noted in Ilam 19. <br /> Month Dey year <br /> T Signature <br /> y Primed/Typed Nam. <br /> DHS 8022 A(1/88) Do Not Write Below This Line <br /> EPA 8700--22 <br /> (Rev.9-88)Previous editions are obsolete. YELLOW: GENERATOR RETAINS <br />