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.02/18/_04 WED 08:18 FAX 559, 38P -t31 CHEM WASTE MGMT KHF [x]005 <br /> Lieb tfomi Agency CUT, <br /> E o—Fnvirpnmonlo!F!raleelion See Instructions on back of 6.' De artment of Toxic'Su6stancmol.' <br /> Form Approved OMB No.2050-Or 9(Expires 9-30-99) a P• _ p <br /> Plmse prink or type. Farm deslgned for use on alife'(12•plkh)lypcvritar. 511aramenta,Catifornic <br /> 1. GeneratW4 US EPA ID No. Manifest Dutarment No: 2. Page 1 Information in the shaded areas <br /> ' M IIaZAIZDOLlS` Is real rcquired.6y Fedaral(ow_ <br /> WASTE MANIFEST f A IR INID I Q 10 15 19 b.121"- of ' <br /> 3. Generalor's Name and Meiling Address A.,State Manifest Documant Number <br /> H :J HE INZ CO LP . .2.2015604. <br /> t) ST KTO -95206-3242'" G.6?.10. <br /> CA .•., :: ...... :.....: <br /> 2800 S CALIFORNIA ST B. Steve <br /> In e-92emlofs Phone)5 I _ej 7 <br /> .s S. Transporter 1 Company Nome 6. US EPA ID Number C. Stole Transponds ID Ra:orvod.] <br /> 4 .. <br /> b <br /> D. 7rorwporso/s.Phone� nQ <br /> ai 7. Transporter.2 Company Name +, B. US EPA 10 Number E. State Transpanc's ID Roserved.1 „ <br /> F. Tronsporto Phone <br /> IJ 9. Designated Facility Nan*and Silt Address 10. US EPA ID Num6or G. Stale Fadlily's ID <br /> z CHEMICAL' WASTE MANAGEMENT,- INC. <br /> c. 35251 OLD SKYLINE ROAD H. Faafiry'sPf�orae. <br /> o KETTLEMAN CITY CA 93239 o IC JA IT 10 10 10 16' 4 16 11 ] 17 (209}386-9711.. <br /> 13, Conloinyrs 13. Total 14. Unfl <br /> Q 11, US DOT Deserlplion lincluding Propos Shipping Name,Hazard Clow,and ID Num6er) <br /> V No. 7 Geantity Wr/Vol I: Waste Number <br /> ? (TREATEDRGDHCbAfTDAOTfINATDTu1THLID, Stare <br /> G ARSENIC AND CHROMIUM) / EPA/other <br /> 0 N' b- <br /> $tale..•: <br /> so E <br /> , B <br /> A c. Sto* <br /> o T' <br /> m O EPA/016'r <br /> � d <br /> slate' <br /> Z <br /> W , <br /> V EPA/Olher <br /> W <br /> Ln J. Ad anal DeNcrlpll ns for Materials Ustod Aho" K'Handling Code,for Wastes listed Abova <br /> Z <br /> O <br /> a. ECQ34Q .. <br /> LU <br /> _ c d. <br /> I <br /> Z IS. Special Handling Instructions ond•Additional Information <br /> O <br /> a CHENTREC Emereency Restlense Number 45.00)424-9300' VMI Contract <br /> Z <br /> .�..� 16, GENERATOR'S CERTIFICATION: I hereby declare 161 the contents OF(his consI mment aro felly and accurately described above 6y proper shipping name and are d6uifled,packed, <br /> Umarked,and labeled,and are in o0 respous in proper condition for transport lay highvrvyaccording to appLLca6k inlefnotiono)and.metional gevornmenl regulalioru. <br /> IF 1 am a forge quantity generator,1 certify that I htrvar a program in Platt to reduce oho valaaw and tareicity eF waste generated to the degree I have determined to Ise ceonomlxllr <br /> CL. proetlea6le and that I have selected the rodicable method of tmalmenl,storage,or diaposal currently a.aila6le to me e+hich minimizes the present and future threat 10 human health <br /> and, <br /> environment;OR,if I am a small quantity gmerolor,I have meds a good Failh effort to minimae my.+rife generation and solcct'tho best wrosfe:manogemenf method that is <br /> O-41-k-Ic to me and that I cop afford. 9 to <br /> O P7.17VT amc Si rales Month Day Yoor: <br /> Z aGl '. p .S ' 3 0 13 <br /> W T 17. Trans over 1 A no-le emenl of Recal t of Materials <br /> O p <br /> W Y Prinled/Typed Name, Signol:+r Month .Day". Year <br /> w s t�AUr 0 � <br /> s� p 1 S. Trans over 2 A;kncwled emenl of Recei 1 of Materials <br /> O T Prinlad/Tiped Name• Signature .' Month Day Year.. <br /> Q R , <br /> V 19, Discrepancy.Indication Spam ' <br /> A <br /> C <br /> I' -29AFacilityOwner ar O erafor Get ifleotian of roses i OF hazardous materials i:ovarad rhis manifest area f as noted in Item 19. <br /> T ri ed/iyped Nema Signature• Month Day Year <br /> Y 14 C <br /> DO NOT'W LOW THIS:UNE.'.." <br /> DISC g024A 11/991. -F-^F'S-ni4Ds TLIIS CCF-,TO'GtSC.\,!ITH:W 30 DAYS. <br /> ic: <br /> EPA 8700-22 P.O. E:>x �OQO. Sac�nmrniO. C q' u5612 :. <br />