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State of California—Health and Welfare Agency / DKpartment of Health Services <br /> Toxic Substances Control Division <br /> Sacramento,California <br /> Phess print or type. (Form designed for use on able it 2-pach3 typewr ler.) <br /> UNIFORM HAZARDOUS 11.Gerverator's US EPAID N(. ernes, 2.Page informationlnthe shaded areas <br /> WASTE MANIFESTCAD 9 8115 8 9 8 3 . D?cument N of ! is not required by Federal <br /> 1 t law. <br /> n at s Name a ding r s a n' mrt urt�artt umber <br /> aMornia epi. o transportation p j O C <br /> 1976 E. Charter Way Q ``�! v : <br /> Stockton, CA 95201 amrs <br /> 4. Generator's pnone ( 2 0 9 9 3 5-2 0 7 65. <br /> ranspower 1 Company Name US EPATTWL—imber tats ransporter's 10. <br /> Chemical Waste Mana ementXin CADO039-86718 • • ransponslr: Phone <br /> 7. Transporter ny Name —US EPA 1D umber qte <br /> F. ranaporter s -F,. <br /> 9. Dosignstpd Facility Name and tits Addrazz US EPA ID NumberStale aj <br /> ,... <br /> Chemical Waste Management, Inc. ` <br /> 35251 Old Skyline Road <br /> Kettleman City, CA 93239 rocnityaxv <br /> CAT0006.46117. = <br /> 11.US DOT Description1 .Containers114 -,^ <br /> J1ne ludinQ Proper Shipping Name,Hazard Class, and!D Number) Total Unita No. T Quant" <br /> ' � Hazardous Waste Solid- N.O. S. ORM-E NA 9189 DT r <br /> A b + <br /> d. <br /> �t1!SF <br /> Usted <br /> 4 �i ,r rt ;;. K. nd"Codes fw Washes <br /> t4'" '�, <br /> t;Zr <br /> I J `i ,�'rR�ylly` + '[.}"�; .�'�, •`y 1�t'r`f1 4,`��-k{ '' „+�iJ'.n.. yF 13 tl �y�1, ._ �S. Y,J1�_ .� ,� �bd,,,,+�, �S ��1�Ff ., <br /> 'st.J'H i ©. � ( .,�.� 4.•-11 ".�5.......,.:._ .•.i ,�. 2�..,may• .�moi. <br /> 15.Speci <br /> Ing nsuuctlons a mons orrnatan <br /> i <br /> her era that the contonts orf this consignment are N4 and accurately disiscrLilged <br /> aborta by proper shipping name and are clessif led,packed,marked,and labeled,and we in all respect:in proper condition for <br /> transport by highway according to applicable international and national govern I r lations. <br /> Data <br /> i Na Signal Month Do" Year <br /> LE.�� 3 e� d6 <br /> 't 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> A Print yped Name OwlMonrh Dey r <br /> M <br /> a ' <br /> P <br /> 0 18. ro ar 2 Acknowledgement eceipt of Materials' Date <br /> T Print Namelure Month Dar Year <br /> a <br /> a <br /> 1 S.Discrepancy Indication Space <br /> I <br /> R <br /> t. <br /> I 20.Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifelst except as noted In <br /> T <br /> hem S. <br /> Date <br /> arts! Signature Alonrh • ear <br /> Cwr <br /> Dt rs 9022 A(7/$4) White: TSDF SENDS THIS COPY TO DOMS WITHIN 30 DAYS lr.: <br /> (EPA$700,22) TO: P.O. Boz 3000, Sacramento, CA 9512 M � <br />