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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of -3e 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch, niter. -V _ Sacramento,California <br /> ' 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST n U :? L L 9 1 > a 1 ) ' of <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> 98756003 <br /> Ln <br /> n5- 4. GL,%,t1 JT&EETE, 370-c:,,TON11 ...�. x3206 B. State Generator's ID <br /> A. Generator's Phone (;'tip ) /+01 t3302 <br /> t\ <br /> c� 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID <br /> of <br /> r:�Tlv 7' r T L ���.n Y � A 1� /1 /. 0 f7i ^ C C 5 D. Transporter's Phone y, 3 — <br /> 9 in 7 <br /> a? 7. Transporter 2 Company ome, 8. US EPA ID Number E. State Transporter's ID <br /> QF. Transporter's Phone <br /> U 9. Designated Facility Name and Site Adi ress 10. US EPA ID Number G. State Facility's ID <br /> i f r �- I •! <br /> r.. L" t H. Facility's Phone <br /> f, 4 .� .) 0 L I''- (.310) 537-7100 <br /> `Q Q r 12. Containers 13. Total 14. Unit <br /> U 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/vol I. Waste Number <br /> L Z o. State <br /> 343 <br /> r <br /> 3 G l ^?ri / EPA/Other /A <br /> E b 01011 T State <br /> o N <br /> 00 <br /> act E <br /> v REPA/Other <br /> CN <br /> A •. MLLLl <br /> "IS WASTE STRIEW" State <br /> o T <br /> co o FOR RECYCLING AT THE <br /> RMENNO/KERDOON FACILITY IN COMPTONI. EPA/Other <br /> t- d CALIFORNIA.THIS FACILITY H State <br /> Z <br /> LU <br /> PERMITS TO RECEIVE YOUR WASTE STREAM AS EPA/Other <br /> LU <br /> n J. Additi n I scr' s K. Handling Codes for`Nantes Listed Above <br /> Z ���� ,. G YC 10`�-80% b. <br /> N DTETHYLENE GL L 10%-80%LU <br /> d I <br /> WATER 10%-60% C. d. <br /> J <br /> Q <br /> O15. Special Handling Instructions and Additional Information <br /> Q 'AND ',E +0 'SOUR <br /> 'SHA/SARA TRr'1iN D 7 <br /> w - <br /> F��RMCY COWFACT: 371-5747 <br /> 16, GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantity generator,I certify that I have o program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> CL practicable and that I have selected the practicable method of treatment,storage,or disposd currently available to me which minimizes the present and future threat to human health <br /> V) 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 /> ad available to me and that I can afford. <br /> >- Printed/Typed Name Signature Month Day Year <br /> Z \;N I t, .� f Lam- —_ 01 -j ! 7 <br /> w - <br /> T <br /> 4 17. T ns orter 1 Acknowledgement of R et of Materials ^ ! <br /> LLJ A Printed,{; /V' fLl-{ v ! V.T!�Q �r Signature Lyr�/1A.(ir ,A,/• :�. t.!• ��'' <b56nth/ `•F'Y�1 Y ar <br /> R V yW _. l7I /� a <br /> LU s <br /> 919P <br /> � 0 18. Transporter 2 Acknowled emenf of Receipt of Materials <br /> T <br /> R Printed/Typed Name Signature Month Day Year <br /> U-1 <br /> LOR � <br /> U19 Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> 1 <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 Printed/Typed Name Signature Month Day Year <br /> 17 7 <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: -SDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (4/97) Generators who submit hazardous waste for transport our-of-state, <br /> EPA 8700-22 oroduce completed copy of this copy and send to DTSC within 30 days.) <br /> APR - 5 1999 <br />