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UNIFORM HAZARDOUS 1.GGenerator's o. Manifest 2.Page 1 Informationinthe shaded areas <br /> document No. is not required by Federal <br /> WASTE MANIFEST CAD981158983. . of3. 1 leve- <br /> Gan srow's-Ramo a ai inq Address 1441�v6s ment.Number.. <br /> California Dept. of Transportation , <br /> P.O. Box 20489g201 4 <br /> Stockton, CA2 Q Generator's <br /> 4. Generator's Phone t 9 4 8-7 8 0 8 9 8115 <br /> ;.i.4. <br /> 5. <br /> rsnspowar I Company Name 6. U3 EPA ID Number tate ransponer s••- ,- , -L.j. <br /> Chemical Waste ManagemantsvCM003986718. . . ransponsra. <br /> 2076 <br /> 7. ransponsr parry ams U PA ID Number na <br /> tats-, ranapor s ID ` •. <br /> . . . . . . . . . ransponer ,sr. <br /> 9. <br /> saignst act sty erne a tte Address U EPA ID Number tats ace sty a , <br /> Chemical Waste . Inc. , Kettleman Hills Facility -•�. j t r ' - <br /> 35251 Old Skyline Rd. <br /> Kettle an City, CA 93239 satt�ta ane k �*G1 j `; <br /> CAT000646117• ' 209'386' 971.]. .. <br /> 12.Contsinors 13. 14. i <br /> 11.#1S DOT Description(Including Proper Shipping Name, Hazard Cla.sx, and IO Ndmber Total Unit <br /> a <br /> No. T e Quenu Waste No. <br /> to •. r.-.`;�: <br /> [ Hazardous Waste Solid N.O.S. ORM-E NA9139 001 D7 Y <br /> it <br /> A b. _ <br /> T <br /> it <br /> d. 'llommartwIlaw <br /> _ .^ Asnwu-4LCodM for waaesusted, w. <br /> " t ; Hyd,ocarbgn� �' -� ,rte„ ",,� '• <br /> of r"� � � 5^,•f �'' �^�.' .l� + r � � <br /> :i{ ti, df <br /> I&Sped- Handin kmwum— <br /> 'c-ALTH <br /> ars that the contents o is eonsignmerK are fully and aceurat i <br /> above by proper shipping name and are classified,packed,marked.and labeled,and are in all respects in proper condition for <br /> transport bT hlgftway according to applicable international and natkxwl govemmonut regulations. <br /> Date <br /> .Prirt Nr. me Sign� ator Mon"P ZA.-Ilr-1 t <br /> h D 1 Y l <br /> e el a <br /> T 17.Transporter- 1 Aeknowlsdgemnnt of Receipt of Materials Date <br /> A Printed./Typwt Name Signature Month pay Year <br /> N <br /> 0 IS.Transporter 2 •AckrKlModgemem or Receipt of Materials' Date <br /> R <br /> T Printed/Typed Mame Signature Month Day Year <br /> [ <br /> R <br /> 19.Discrepancy Indication.Space <br /> r <br /> A <br /> G <br /> i <br /> L <br /> T 20,Facility Oer or Operator Certification of receipt of hazardous materials covered by this mandgst except as noted in <br /> Item 9.wn <br /> Data <br /> Print , rims Signature Month Day Year <br /> Blue,-• GENERATOR SENDS THIS COPY TO DOHS WITHIN 30 DAYS <br /> ra 9022A(7/«) To: P.O. Box 400, Sacramento, CA 45802 <br /> A$700-22) w airs r <br />