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a—Health and Welfare Agency Department of Health Services <br /> For <br /> OMB No.2050-0039(Expires 9-3 "'1) Toxic Substances Control Division <br /> Sacramento,California <br /> Plea �1 pe. (Form designed for use on 12-pitch typewriter). <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest 2. Page 1 Information in the shaded areas <br /> Document No. <br /> WASTE MANIFEST of is not required by Federal law. <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> SUAM CONTAINERS CORPORATION $9$9 g$ <br /> 1815 NAVY DRIVE, STOCRTON, CA 95206 e. state Generator's ID <br /> 4, Generator's Phone ) <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID <br /> r^����a r I A ..d C��E-44ICAL CORPORATION D. Tranaporter's Phone <br /> 1 s i. <br /> A1151. 4-1 <br /> N8. US EPA ID Number E. State Transporter's ID <br /> U) 7. Transporter 2 Company Name <br /> m <br /> o F. Tranaporter's Phone <br /> 0 <br /> m ID <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's <br /> 171 <br /> Pr-10C CHEMICAL CORPORAMON 141512161 r <br /> Q H. Facility's Phone <br /> 2u8)l Ray Road <br /> a tae Palo AJto, CA 94,303 _A(',1jAlI3j InIO141919 R115171 424-1 <br /> Z <br /> 12. Containers 13. Total FG <br /> 0 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Waste No. <br /> W No. Type <br /> J State <br /> 0 a. WASTE FLA)MLl�BLE LIQUID N.O.S. <br /> E Fl- MABLE UN #1993 (FO05) 0 6 3 D M 0 3 4 6 5EPA/617005 <br /> 3 NE b. IIS WASTE, LIQIIID9 N.O.S. state <br /> o R 15 00825 134A (METHYL ETHYL KETONE) ORM-E NA 9189 23= D G EPA/Other <br /> c9 T <br /> �* O <br /> a R c State <br /> T <br /> KawXXTE 8330U= <br /> EPA/Other <br /> aim WE a <br /> State <br /> Z d RESIDUE LAST CONTAINED - COMBUSTIBLE LIQUIDS EPA/Other <br /> 0 (F1� Tf DRDMS) COMBUSTIBLE LIQUID NA 1993 0 0 3 D - 0 Oil 2 5 P <br /> LU I <br /> a) J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> 0 A. PROFILE #0108417 MBT UL ETHYL KETONE, BUTYL CELLOSIOTE a y b. <br /> B. PROFILE #013629 WATER, METHYL ETHYL KETONE, : <br /> W SPIRITS, BUTYL CELLOSOLVE, MAGAUDR01 L-67 c� _ - . � d. <br /> a N u I i9gO <br /> Z <br /> 0 <br /> F 15. Special Handling Instructions and Additional Information ENVIRONMENTAL HEALTH <br /> Z PERM IT%SERVICES <br /> Cloves, Goggles, and Protective Clothing- <br /> 19o7 04 <br /> J <br /> J <br /> 18. <br /> U <br /> GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> d national government regulations. <br /> u) <br /> ¢ If I am a large quantity generator,I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determine <br /> to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> 0 <br /> 0present and future threat to human health and the environment;OR,if 1 am a small quantity generator,I have made a good faith effort to minimize my waste <br /> U generation and select the best waste management method that is available to me and I can afford. <br /> Z Month Day Year <br /> WPrinted/Typed Name DW CARB�Y Signature <br /> � 1p 11, 61910 <br /> W <br /> WT 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> Z R <br /> Q A Printed/Typed Name Signature Month Day Year <br /> N <br /> 0 S (Jaid <br /> P 18. Transportef 2 Acknowledgement of Receipt of Materials <br /> Q RPrinted/Typed Name Signature Month Day Year <br /> U E <br /> Z_ R - <br /> 19.?tjMarjXjdication Space <br /> A On: <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T <br /> y Printed/Typed Name Signature Month Day Year <br /> JOHN SLRt.01/GREGORY ELLISON/RAY BOROWSKE <br /> QHS 8022 A(1/88) Do Not Write Below This Line <br /> Re 8700-22 <br /> -88)Pr Blue: GENERATOR SENDS THIS COPY TO DOHS WITHIN 30 DAYS <br /> ,Rev.9-88)Previous editions are obsolete. <br /> To: P.O. Box 400, Sacramento, CA 95812-0400 <br />