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No. <br /> HarmApprovedOM8For designed <br /> (Expires0-36-991 See Instructions On back of page G. Deportment of Toxic Substances Control <br /> %ease print br type. form designed/or use on elite(12-pirch)yr "roc t, <br /> Sacramento,CeliFornia <br /> 7CIAILIS10161112191219121 <br /> 1.toi s US EPA ID No.NIFORM HAZARDOUNwniFest Document Nc2. Pagel Inkrmation in the shaded ureas <br /> WASTE MANIFEST is not required by Federal law. <br /> 8 7 4 3 °f <br /> 3. Generator's Name and Moiling Address (EMERGENCY, SEE BOX 15) A. State Manifest Document Nalim <br /> i <br /> BISHOP INDUSTRIES; 551 CARME#IE <br /> i MANTExA, CA 953371 B. Stale Generator's ID <br /> I a. cen«am;. PharI x91823-938TT : DDNE E X E N P 7 <br /> V 5. Transporter 1 Company Nome 6. US EPA ID Number <br /> C. Slate Transporter's ID(Reserved.I <br /> o � tcu <br /> SAFETY-KLEEfl (TS) INC $ C R9191910, 7 4 5 9 1 D. Transparar'sPhone II1 (916) 375-2611 <br /> 0 7. Trans iter 2 Company Noma <br /> P° P Y 8. US EPA ID Number E. State Transporter's ID[Reserved.) <br /> M P ENYIR[AIMENTAL CAT 0 0 0 6 2 4 2 4 7 F. Tionsporter'sPhone t890) 245-9518 <br /> 9. Desi ated Facility Nome and Site Address ' <br /> i SAFF�TY-KLEEN (SAN JOSE ) INC. 10. US EPA ID Number G. State Facilitys ID _ <br /> 1921 BERRYESSA BLVD. <br /> SAM JOSE, CA. 95133 ICIAID1915 9 4 9 4 3 1 9 951-5009 <br /> j 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) 12. Containers 13. Total 14. <br /> Unit <br /> No. T Ouan6; Wt/Vol Number <br /> ° .S. (ACETONE, <br /> POLYESTER RES'IN), 3, UN1993, pGII ( p00 212 <br /> G J EPA/ahr, <br /> i N b 0 D N -on. D991 <br /> h A c Aler <br /> E <br /> r IA0.7 <br /> T State <br /> i O <br /> R t EPA/Other <br /> d <br /> r 'Stare <br /> I <br /> I <br /> EPA/Olher <br /> 41 D sSEL Ustad Ab <br /> I yf -Dn ss ADD P003 ave <br /> i c g Cadet For Wo,es J sad A ,.. 4.. - <br /> ( f; <br /> � o Mot els <br /> Iib} ) a <br /> dr b <br /> } / <br /> 15. Special HandlingInstructions and Additional <br /> Information IF UNDELIVERABLE, RETURN TO qUERATOR. IN EMERCHNCY, <br /> CALL 3-E li 1-809-468-1760 (515-205). AVOID CONTAfET 'AND Y PROTECTIVE GEAR. A/%y�7 <br /> T EMERGENCY RESPONSE GUIDE ROOK NUMBERS: Ile) 128 llb) tai Ile) lld) <br /> M 1549840 <br /> t <br /> Ib. GENERAT <br /> Od l CERTIFICATION: hereby declare that the canniest,F of this consignment era fully and acc ate)Y described nacre l proper shipping name and are classified,pocked, <br /> marked,and labeled,and are in all rmpeds in proper condition for transport by highway according t applicable international and national government regulations. <br /> IF I am a largo q entity generator,1 certify that I have a p oggram in place to reduce the volume ondxicity of waste e�a abd to the degree have determined to be economical <br /> practiw6le and that Gave selected IM practicable methodrof treatment,storag or dispo I curreety pyadable to m. Mth to <br /> the present and future threat to human It= <br /> and the environment;OR,IF 1 am a small quantity generator,I have made a good faith effort to mmiFM a my waste generation and select the herr waste management method that is <br /> available ro me and that I can afford. <br /> Prinro Typed to me Sign Nn Month Dvy Ywr <br /> O \ O 1 6 <br /> T I7. Trans iter1 . owitc en o Receipt of Materials <br /> R T <br /> MPrinted/YPed Nome Signature Month Day Yeor <br /> S <br /> P <br /> M 18. Trans iter 2 Acknowled ement of Receipt of Materials <br /> T Printed/Typed Name <br /> E SignaNre Month Day Y.,r <br /> R <br /> F 19. Discrepancy Indication S ' <br /> A <br /> C <br /> I <br /> L <br /> 20. Facili Owner or O rotor Certification of recsi t of h ordous m ' Is covered this manifest except as noted' m 19. <br /> 12 <br /> T Printed/Typed Name Signature Montle Day Year <br /> Y <br /> 1011 , DO NOT WRIT ELO THIS LINE, i <br /> I <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> FSC 8022A(1/99) IGenerators who submit hazardous waste for transport out-of-state, <br /> 'A 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />