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StesIll,of blifornia—Environmental Protection Agency r s <br /> �Ea 'ro4edOfs18 No:2D50-0039IEipires930991' 4 p `See..lnSStrucfions�rDOCKOf �ol� -P p <br /> d t �er 'l 9 Department of Toxic Substances Carmel <br /> �Pfq, t . Form designed kr use on elite(12-pitch( rirer z; Sacramento,Cahforttio <br /> UNIFORM HAZARDOUS 't US EPA IO No. MoniFesU cumenl 2 Page 7 Formation in the shaded areas <br /> a' WASTE MANIFEST c is not required by Federal low. <br /> Qenerator's Name and Mailing Address . A. State Manifest Document Number <br /> r�Fy NTER Cc �s c 3 <br /> I100 HARLAbf RP Bslate Generator's ID <br /> L <br /> 04 <br /> . <br /> � Cato779 LA7THkCP, to ?5 "' _' <br /> 4 Generrs Phone I. 1, ,> r: <br /> IA IR 11 E Q 2IS 11 1A IR I <br /> sN 5. Transporter 1 Company Name 6., U US EPA ID Number C. Stale Transporter'ss10[Reserved.] <br /> m <br /> =NIVAR USA O INC : D. Transpoder's Phone <br /> M.� i 1.4JR n it P 1 9 i ? <br /> VV 7. Tronspgrter 2 Company Name .!8. US EPA ID Number E State Transporter's ID[Reserved.] <br /> Q "NTtiAR uSF, Ii'.T' fr <br /> 1, Tronsporters Phone <br /> � P A O 9 2 5 7 F• _ <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Stale Facility's ID <br /> XJa OLLUTICN r;ONTROL I1IDUSTRIEE . <br /> »� 343 KENNEDY AVENUE H. Facility's Phone <br /> t*0 AST EHICAGO, IN 463i_ <br /> �Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 1 13. Total 14. Unit <br /> U No. Type Quantity Wt/Vol I. Waste Number <br /> "K. WASTE FLAIIMABLF LIQUIDS, xI U. ., State <br /> t „ +IPRCDYLCOF CL COL XdQ It IAE'THYL ETHER; <br /> 3 G h1t.UNI 94 , PG I1 I IRD=1 EPA COO i.) . 'EEG lie8 3 61011 !.. EPAJOrher <br /> lT n . <br /> o' b`ICN R 'SA HAZAR :tJUE WASTE, LIIQLIIC I ABB iDREcNT ?Atli smie" <br /> co E +FTH l?E ::BAA GER CLEAVID Q RZ8IrFUE' P4 other <br /> Aolo. 010111010 P <br /> o T "NON-I. GA YtA R OUF WAS'TE, LIQUID sm"re` <br /> RPA7Other <br /> 6 ima 0131 <br /> rd' � rale F <br /> Z <br /> w <br /> U EPA/Other <br /> its ' <br /> Z <br /> J. Additional De3criPlions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> 0 a b. <br /> - 1 U14 b ti'b :fa <br /> tyii It }LU,d4 CIE A:BSOREEIrl WITh FG <br /> 55 IMAµ, 890. WZT rr Tc F d. <br /> a i <br /> 15. Spacial Handling Instructions and Additional Information WEAR APPROPRIATE PROTECTIVE GEAR WHEN HANDLING, <br /> Z MEPGENC CCNT ' HEMp RE : 1-900-424-9300, CALLER MUST IDENTIFY UNI`>:AR USA A <br /> KIPPER �1 <br /> L rARCPl '1 „E➢ BY CAknIEP.iSHIFFE$ ( <br /> S! DRIVER SIGNA'T+!RE' <br /> 16. GENERATOR'S CERTIFICATION: Ihereby declare that the contents of this consignment are fully and accurate)y described ab eby proper shipping name and are classified,pocked, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nation government regulations. <br /> J If I am a large quantity generator,I certify that have a program in place to reduce thus volume and toxicity of waste generated,yy the degree I have determined to be economical)yy <br /> Npracticable and that I have selected the racticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human heolth <br /> 6, and'he is <br /> OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> O ...available to me and that I can afford. <br /> VPr. d Typed Name f / Signalur- Month Day Year <br /> Z W ' Al Oil j 2— Z. 6 <br /> 'w R, 17. Trans orter I Acknowledgement of Receipt of Materials <br /> R <br /> w p ,Printed/T pad Na a Si tura <br /> ` R R Month °]Day Year <br /> K'y S Li <br /> L Z <br /> s D I B. Trans oder 2 Acknowled emeoial Receipt of Materials <br /> RT Printed/Typed Name azure <br /> H E / Month Day (JYear <br /> U 19. DiscrepancyIndication Space <br /> Z P <br /> — p <br /> C <br /> I <br /> L <br /> 1 20. FacilityOwner or O orator Cedification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Pried/Typed Name Signature - _ Month Day Year <br /> Y .d <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) (Generators who submit hazardout waste For transport out-ol-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />