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State of Cal'forrua--FaKronmeraal protection Agency <br /> Form Approved-OMB No 2030-MIP(Expires 930.94) See Instructions on back of page 6 Department of Toxic Substances Control <br /> Please print or type Form designed for use on elite(12pd6)typewrder Sacramento California <br /> UNIFORM HAZARDOUS 1 Generators US EPA ID No Manifest Document No 2 Page 1 J Information in the shaded areas <br /> of I rs not required by Federal law <br /> WASTE MANIFEST C a o Z i <br /> 3 Generator's Name and Mailing Address <br /> VV <br /> �s <br /> rid 4 Generators Phane4 67) 7 67 C7 !�7 5 W <br /> 3 Transporter 1 Company Name 6 US EPA ID Number <br /> FNVTROPUR WEST ICI AITI s <br /> 01810101 1111015191 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number <br /> I(1 <br /> r <br /> Ia 9 Designated Facility Name and Site Address 10 US EPA ID Number <br />•ce EIN-VIRUPUR FEST <br /> t 13331 N. HWY. 33 <br /> iu PATTERSON CA. 95363 ICIAID1018131116jeJ7 2 8 <br /> IZ 11 US DOT Doscnphon(including Proper Shipping dame Hazard Class and ID Number) 12 Containers 13 Total 14 Und <br /> No T Duan Wt/Vol <br />'ai a <br /> 3 G NON RCRA HAZARDOUS WASTE LIQUID �] <br /> E 0 0 1 'T T V G <br /> co N b <br /> E <br /> R <br /> A <br /> T C <br /> O <br /> r. <br /> CE R <br /> u, <br />~ d <br /> Z <br /> W <br /> u <br /> O a Cady far 1(fla�bes Ap <br /> XW <br /> 1 <br /> Z Ae <br /> 0 15 Special Handling Instructions and Additional Informahon <br /> r 24 HR. 1:MERGENCY CONTACT: PRC #1-(800)-874-4444 <br /> Z 24 HR. EMERGENCY RESPONSE: CHEM TEL INC. #1-(800)-255-3924 <br /> uj APPROPRIATE PROTECTIVE CLOTHING S RESPIRATOR. <br /> 16 GENERATOR'S CERTIFICATION I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and ore classified, <br /> a packed,marked,and labeled,and are to all respects in proper condition for transport by highway according to applicable federal,slate and international laws <br /> V <br /> r If l 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 <br /> economically prachcable and that 1 have selected the prachcoble method of treatment storage or disposal currently available to me which minimi-es the present and futvre <br /> threat to human health and the environment; OR, if I am a small quantity torator I have made a good faith effort to minimize my waste generation and select the best <br /> witiste management method that is available to me and that I can afford <br /> 0 Printed 'ped N ro ` �t—(� Signator Mont r <br /> T 17 Tr r 1 Acknowledgement of Receipt of Materials <br /> Uj w Printed/T Na t Signature r <br /> Ws ✓ -k-1 �f�t s' .ti. <br /> 0 18 Trans r 2 Acknowled emernt of Receipt of Material <br /> w t Printed/Typed Name Sngnowre Month Day <br /> 0 e Year <br /> to <br /> N19 Discrepancy Indication Space <br /> u A <br /> Z C <br />_# 1 <br /> 20 Facrh Owner or O roar Certification of receipt of hazardous materials covered this manifest exce os noted in Item 19 <br /> Prmted/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE <br /> DTSC W22A (7192' <br /> EPA 8700-22 RECEIVED 0 C F 2 7 1994 Yellow GENEPATOR RETAINS <br />