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Stall of Colifornio—EmironmenNl ProtectionAgency - (tee <br /> Far Approved OMB No.20504039 Espirito 9-30991 �� See Instructions on back of pees/6. Department of m.ia sab,teec.r CentralPlease pript or type. Form dm�grled for use an elite rl2pfrch)ypewribr. Sacramento,Califomlo <br /> r UNIFORM HAZARDOUS 1. G'enerator's US EPA ID No. MaiDocument No. 2. Pagel Information in the shoded areas <br /> isnwreauadbyFederalI.- <br /> WASTE MANIFEST <br /> Ll 010101 11 8 219181 71 1 1 1 1 or t <br /> 3. Generator's Name and Mailing Address A. Aute Manifest Decurrent Number 23406766 <br /> TOM NEWHALL BOAT REPAIR <br /> 0 8090 RIO BLANCO RD e. State Genstalar•sID <br /> STO <br /> runs moserNA 95219-8703 <br /> ihone 1 2091 477-4285 <br /> -en Tromporrh1ee 1 Canon,yy Name 6. US EPA ID Number C. Aare Tro sibei ID[Reserved.I <br /> ..,� �tiOW�vOed iY[�Ve�eOnMM.f.16� �V ECS <br /> D. Tronspo er's Phone <br /> f4�—T - 7. Transporter 2 Company No 8. US EPA ID Number E. Stare Tranapwter'r ID[Roenad.] <br /> F. Tramporler's Phone <br /> `T <br /> W:5�U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State facililys 10 <br /> CHEMICAL WASTE MANAGEMENT, INC. Valqll� I] <br /> '1 35251 OLD SKYLINE ROAD H. facility's Phone <br /> M0 KETTLEMAN CITY CA 93239 0 0 614161 1 1 7 (559)386-9711 <br /> (VU 11. US DOT Description(including Proper Shipping Noma,Hazard Class,and ID Numbed 12. Con iners 13. Talar 11. Unit <br /> No. T Ouas 1, Vol I. Waste Number <br /> Z a NON RCRA HAZARDOUS WASTE SOLID, Aare <br /> SOIL CONTAMINATED WITH 1 ,920 PPM COPPER 181 <br /> 3 G rei II i O EPA/CnMr <br /> o N b. Aare <br /> m E <br /> I I EPA/Oder <br /> A <br /> T a' SMte <br /> m O <br /> R EPA/Ods <br /> as' <br /> w Stete <br /> Z <br /> Z <br /> V EPA/Oder <br /> w <br /> irs J: Additional Descriptions far neaten a Used Aber K. Handling Cad.for Wastes Listed Abase. <br /> a. EC545t6. <br /> 00 <br /> d. <br /> 15. Special Handling lnnmdiam d Additional Inherent <br /> CHEMTREC Emerge cy Response Number (800)424-9300 WMI Contract <br /> Z <br /> w <br /> i <br /> QCERTIFICATION: Iherebydeclorethottheconnnbofthb comig nt are Fully and accurately described above byp per hippng name and are classified,pocked, <br /> U <br /> overd,and labeled,and are in all respects;in proper condition for nrompon by highway according to applicable international and rolianal gayernment regulations. <br /> J If I am a large qui generator,1 certify that I hose a program in place to reduce the volume and hurrah,of warm gsearored to she degree I hairs,d ermined to be rearmi <br /> w <br /> pro,ticable and that I have selected the practicable method at Paramount,storage mm <br /> or disposal currently available Io e which minimizes the present and future threat huan mhealth <br /> and emironmenp OR.if I am a small quanRly generator,I have made a good forth effort to minimize my waste gone tomRnd sated the best wa,*management method The,is <br /> O available to me and than I can afford. <br /> y Printed/Typed Nome / Signature Month Day Yom <br /> Z O nr n,� i y//urs <br /> 0 t O <br /> T17. Trans Mr I Acknowledgement of Receipt of Miamrids <br /> Printd/Typed Name Sig MonLd Doy Yew <br /> Lu F s �'(Vl ¢ E3 <br /> P <br /> a 18. Trans s 2 Acknowld smell of Receipts I Materials <br /> O I Printed/Typed Name Signature <br /> w MonDayth yourf <br /> q R <br /> lzQJed <br /> F wep19. Disonq Indicter Space <br /> 2 <br /> _ p <br /> C <br /> I <br /> L <br /> 1 1 20. frocilibLghwereer or Ovemoris'Certification of receipt of hazardouvreateriolliconerried 6 this manifest exciestar noted in Item 19. <br /> T /Typed Nome5i N re Month Day Year <br /> Y . <br /> ujA <br /> DO T WRITE BELOW THIS LINE. <br /> DISC 0022A(1/991 While: TSDF SENDS THIS COPY TO DISC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />