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<br />Slate of California—Environmental Protection Agency
<br />OMB No. 2050-0039(Expirw 9.30-99) See Instructions on back ot.,A9e 6.
<br />ea» print or type. Form designed {or use on elite (12-oikhlwrihr-
<br />Department of Toxic Sub,unces Control
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<br />Clean Haroori has the appfWate PllTO1116 for aria well accept the waste the generator Is shipping.
<br />ITSC 8022A (1/99)
<br />PA 8700-22
<br />Yellow: GENERATOR RFTAINS I
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<br />UNIFORM HAZARDOUS 1. Gensrotor, US EPA ID No. Manifest Document
<br />No. 2. Page I Informafion in the shaded areas
<br />WASTE MANIFEST
<br />CAR 0 0
<br />isnolrequirsdbyFedarallaw.
<br />0 0 0 2 2 7 9 4 5 2
<br />6 a of 3
<br />3. Generators Name and Mailing Address
<br />Advanced Interconnect
<br />555 Carnagie
<br />A. Slate Manifest Document Number
<br />227 y �,^ ^g
<br />2 f{ 30
<br />Street
<br />- - - -
<br />0
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<br />Manteca, CA 95336
<br />4. Generator's Phone (
<br />B. Shh Gen..tcr, ID
<br />-
<br />2109 824-6555
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<br />5. Transporter I Compan Name
<br />Y 6. US EPA ID Number
<br />C. Slits Transporter'. ID
<br />UPPffiblD7430H
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<br />Clean Harbors Erie Services Inc 0 3 9 3 2 2 2 5 f
<br />D. Transporter. Phone -
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<br />7. Tmraportar 2 Company Name
<br />Tal 849-1800
<br />8. US EPA ID Number
<br />E. State Transporter'. ID (Reserved.)
<br />Q
<br />U
<br />F. Transporter', Phone
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<br />9. Dp9nand Fags.. Npms and S,'(e Address
<br />SeaO t'Si'rporS Aragonite LLC 10. US EPA ID Number
<br />G. Suh Faciliy's ID
<br />z
<br />11600 North Aptus Road
<br />0
<br />Aragonite, UT, 84029H
<br />`19
<br />FaciliV!Phone
<br />19 1.
<br />801 32378100
<br />U11.
<br />US DOT Description (including Proper Shippingq.Name, Hazard Class, and ID Number) 12. Cont°finery
<br />13. Total
<br />14, Unit
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<br />`RQ,Waste,No
<br />Oeanlily
<br />Wt/Vol
<br />L Waste NumberQ,BASIC,INORGANIC,
<br />3 G
<br />PL0.3.(AMMONIA, SODIUM
<br />tete
<br />S,951
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<br />-lRQ• Waste, CORROSIVE `LIQUID, ACIDIC, INORGANIC,
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<br />4Jaste, Chlorite solution, 8, UN1908, PG II
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<br />J. Additionalpp�esj5A_Igfiogs for M°terigs listed Above
<br />a: LA'1'!S LP 1X$5
<br />K. Handling
<br />D002
<br />($, C)
<br />Codes for Wastes
<br />Listed Above
<br />b: LATA LP 1x55(3,C) _.......__-......
<br />a.
<br />b.
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<br />c: LCCRD LP 1X55 (9, I, E)-
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<br />d: LCCRO LP 1X16 (L, I, C)
<br />a. d.
<br />5
<br />15. Special .ridliInstructions and Additional Informationrood
<br />y _
<br />LP Profile : CH52059
<br />b:DOT-E-11294
<br />WO#: CJ6077
<br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proparshipFing name ondareda,si8d, pocked,
<br />tomarked, and labeled, and are in all respects in proper condition for transport by highway according applicable international and nallona government regulation,.
<br />j
<br />If I am is longe quantity generoler, I certify that I have a prooggram in place to reduce the volume and loziciy of waste generated to the degree I have determined u 6s ecanomica11Y
<br />pracK<a61a an at I aw »lead the pnclimble method of treatment, storage, or disposal currently available h ma which
<br />and Illi
<br />viminimizes the prueal and future lhredru human heahh
<br />n t I if am a ,mall quantity generator, I have made a good Faith effort u minimize my warts generation and select the best wash management method that is
<br />avails u s n That I can afford.
<br />Printed/Typed �,
<br />_ Signau j��' J p �� �� E� Monlls
<br />40Z w'�/ R N 4 416 Z ' 'DOES. year
<br />17. Tran Her 1 Acknowld emenf of R sit Material.
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<br />Prinhd/Typd Noma SignaNro
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<br />Ryan Piper Month Year
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<br />18. Trans rter 2 Acknowld emanf of Reasi f of Mohriols ll
<br />RPrinhd/Typd
<br />T
<br />Name
<br />Signature
<br />E'
<br />9
<br />Month Day Year
<br />19. Discrepancy Indication Space
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<br />A
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<br />( 20:.
<br />T Prinhd/Typd
<br />Facili Owner or nhr Cernniasmon of receipt of hazardous materials covered by this monifi st ezca t as noted in Item 19.
<br />Nam.
<br />Y
<br />Signature Month f Day year
<br />vV 11V1 VVKllt 6tLVW THIS LINE.
<br />Clean Haroori has the appfWate PllTO1116 for aria well accept the waste the generator Is shipping.
<br />ITSC 8022A (1/99)
<br />PA 8700-22
<br />Yellow: GENERATOR RFTAINS I
<br />
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