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State of California—Env' nmental Protection Agency <br /> 0 Form Approved M8 .2050-0039(Expires 9.30-99) See Instructions on back Of a e 6. <br /> Please print or pe. arm designed for use on elite(12-pitch)typewriter. P 9 Department of Toxic Substances Control <br /> Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Pae 1 [Information in the shaded areas <br /> (FORM HAZARDOUS sFt WASTE MANIFEST A D 8 @ 9 4 1 9 6 @ � ot required by Federal law. <br /> 1 of 1 <br /> 3 enerator's Name and Mailing Address A. State Manifest Document Number <br /> am STM Co 20306140 <br /> h RId CA one�jfQA B. State Generator's ID <br /> (\ <br /> 719 IM-4A19 Contact CHRIS DFMRTMK IN 10 13 16 1218191 41 11 51 <br /> N5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID Reserved.) <br /> g ROMIC EIVIROMM WIL TECH. @ @ 9 4 S 2 6 5 D. Transporter's Phone <br /> (65@)324-1638 <br /> _� 7. Trans Transporter 2 Com an Name <br /> P Company 8. US EPA ID Number E. State Transporter':ID Reserved.] <br /> J <br /> J <br /> i QF. Transporter':Phone <br /> V <br /> Q 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility s ID <br /> -j <br /> Z ROMIC EIVIROMWAL TECH ID@@ 9 ! 15 12161 51 7 <br /> ,0 21181 BAY ROAD H. Facility's Phone <br /> J p C <br /> @@ 9 4 5 2 6 5 7 (65@)324-1638 <br /> Q 1 1. US DOT Descri tion includin Pro er Shi in Name,Hazard Class,and ID Number( 12. Containers 13. Total 14. Unit <br /> V P ( 9 P Shipping <br /> No. Type Quantity Wt/Vol I. Waste Number <br /> EE Z a-YASTE FLAMMABLE L19VIDS, COHROSIM 1.0.S. 3 112924 II State <br /> (M-P 0FINOL,AMMOIIUM HTDROXIDE) 122 <br /> 3 32 <br /> E Ori ' , EPA/Other <br /> E b (�SODIllM MYD80XIDE)RROSIVE SOLIDS, I.O.S. d 111759 II State <br /> CIO v R EPA/Other <br /> 4 A Vlflf 35417A t O !' on K,010 P IME <br /> o T a (DEBCANT�HI1(ATEDSOLID <br /> YITH:gCICAACID)�77 III State <br /> o 181 <br /> R. , r ^ ! C) EPA/Other <br /> o[ (J V <br /> Lu d. ow <br /> t— <br /> Z State <br /> w <br /> V EPA/Other <br /> Lu <br /> N J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> Line Ila. EPA Codes: D@@2 b. <br /> W <br /> o< <br /> c. d. <br /> Q <br /> 0 15. Special Handling Instructions and Additional Information 24 RR MGEYCY RWWE 111. 118* 424.930@ <br /> t= <br /> Q <br /> Z <br /> w <br /> Z <br /> 16. GENERATOR's CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate)y described above by proper shipping name and are classified,packed, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> V <br /> J <br /> If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> Npracticable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> al� and the environment;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 /> >- Printed/Typed Name _ Signature - Month Day Year <br /> w <br /> R 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> w N Printed/Typed Name ' Signature Month Day Year <br /> Lu S <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> E Printed/Typed Name Signature Month Day Year <br /> Lu N <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> L <br /> l 20. cc ility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Re2erante Vule6er: E b8E@371729 -T <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />