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ate of Califokiio-Environmental Protection AzIency
<br /> irm Approved 64 No.2650-0039(Expires 9-'30-99[ - num
<br /> See.Instructions on back of : 6. Department of Toxic Substances Control,
<br /> pose print or type. Form designed for use on elite(12-pitch)tyr to Sacramento,California '
<br /> 11.. Generator's EPA ID No. Manifest Document 2. Page 1- Information in the shaded areas
<br /> UNIFORM HAZ//,�RDOUSy. - is not required by Federal law.
<br /> WASTE.MANIFEST C -.y v ` 0t 1617151 1121819 14 12 g 10 of
<br /> 3e Geherator's Nome.and.Mailing Address., A.,State Manifest Document Number
<br /> >
<br /> Heinz Am,�,,,r� ica � 2 2 �6
<br /> PO BOA{ 57A .rtj.,{c��{sto jr q�{A 95201 B. State Generator's ID
<br /> 4.-Generator's Phone (`209) 932^5 f 5G
<br /> S. Transporter 1 Company Name Inc. . US EPA ID Number C. State Transporter's ID[Reserved.1
<br /> Del e—1Vilfi �. Services,., . r R3 $ 106 .95 � `� 5 D. Transporter's Phone .:?.W:.?J-5��_2!-e,1
<br /> Tran3poYfer 2 Company Name - 8. US EPA 1D Number E. State Transporter's ID[Reserved.] -
<br /> _. F. Transporter's Phone -
<br /> 9. Dees�iignnate}d Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID
<br /> .U&J I.,Rit•df i.lz - i C .s I id�> .7 r'a i'3 ri .',T ri. P 5
<br /> 625 S^^,��,srp Poad �� H. Facility's Phone
<br /> SIS Lvi3Sv k 9r'6r 7 u A 9 � J�7f'A 1'- 2 '
<br /> 1,1, US DOT Description(including Pro er Skipping Name,Hazard CI ss,and ID Number) 12. Containers 13. Total 14. Unit
<br /> _ P ( 9. PP"g No. Type Quantity Wt/Vol L Waste Number
<br /> a. State
<br /> RQ_ X-M SMS,, 9r M 2212, pi�TSi 171> . ` €
<br /> G _ �r§ C EPA/Other
<br /> ololsl
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<br /> N ' State
<br /> E
<br /> i R EPA
<br /> /Other
<br /> t T
<br /> State
<br /> t . .1
<br /> t O
<br /> R EPA/Other
<br /> d. State ,
<br /> 1 '' EPA/Other
<br /> J. Additional Descriptions for Materials Listed AboveK. HandlingCodes,for Wastes Listed Above
<br /> 6.
<br /> 15. S$❑�ecta1 Handlin Instructions and Additional Information to• r m faq
<br /> ,.<7.. ..7 !...'.! slJ!.�•: 530,1662-1841 s��0.10 r;:cif i3
<br /> 2 � X31 �t21'"il r :7c r s + MGM
<br /> San t~7oaquin Walley,AP , 4230 KKi.1..,t="' Ave; .1 sto, CA 95356 `; L;V 64 PL t°Nfell {;r?e,
<br /> ASBEM10S RFMVAL JUKVITPOMP 49 CER 61 (PA.GMD? SFSF' - En ei IMM ME )
<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 /> marked',and labeled,and are in all respects in proper condition for transport bX,higkway according to applicable international and national government regulaTions. 01i
<br /> If l am ala"rge quantity generator;I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree L have determined to be economically
<br /> jpracticable and that I have selected the practicable method of treatment,storage,or disposal currently avoitable to which minimizes the presentand future threat to human health -
<br /> and the environment;OR,if l 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 /> c available to me and that I can afford.
<br /> Pr' ted/Typed Name '. -Pr Signature Month Day Year
<br /> Ol
<br /> RT 17. Transporter 1 Acknowledgement of Recei t of Materials
<br /> -N Pr' ted/Typed NameDR-1 �� �' '0 Sign atur es �.' ^'r Mon, Day Year
<br /> N �t-7- C. lL�i1�L d SEJz t G r c , -�. _ ,�- , ____---- - 0 �1 . 3
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<br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials
<br /> T Printed/Typed Name Signature Month Day Year
<br /> ( B T
<br /> F
<br /> 19.-Discrepancy Indication Space
<br /> L [
<br /> 1 20. Facilitynet or erptor C ti esti of receipt of zordous materials covered by tvisvdnifelrexce4as tkcl,in Ilea{19.
<br /> T Printed/Typed aMe
<br /> Signature nt Pay� ear
<br /> j/)t, a
<br /> Y � / '
<br /> DO NOT WR1 TE BELOW THIS LINE.
<br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS.
<br /> DTSC 8022A (1/99) (Generators who submit hazardous waste for transport out-of-state,.
<br /> EPA 8700-22 .
<br /> produce completed copy of this copy and send to DTSC within 30.days.)
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