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%/ <br />Jul 11 03 10:33a <br />State oF.Cclifornia—Environmental Protection Agency <br />form Approved OMB No. 2050-0039 (Expires 4.30.991 See Instructions on back of p . <br />Please print or hlm. Form designed for use on elite f 12•pf p..'ifer. _1„ <br />p. 2 <br />Department of Toxic Substances Control <br />DTSC 6022A (,/99) D; 'H ` iC --TSC `+JITIUt< ;n Dgyg <br />EPA 6700-22 <br />til•.: I'1<r:tC� �. �, y.^,5 :: <br />UNIFORM HAZARDOUS <br />1. Generator's US EP No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />is not required by fadaal law. <br />.R IV <br />°F <br />ES8 <br />3. Gonerotor',Noun and Mailing Address <br />i r rx�� <br />A. State Manifest Document Number <br />216G6546 � <br />y� <br />/l�jfi J"s�n�v 1,7aiex? +J=es/C,/j c/% <br />��t <br />B. Sha Ganaralar's RD <br />w <br />f <br />A. Generator's Phone (l a�1 �%� � — rel /.S'a <br />` <br />S. Transporter 1 Company Name d. LIS EPA ID Number <br />C. State Tionsporters IC jRe?MCLtd.j <br />r <br />VEXREEN EltAFiROWENTALSENCES 161 Z <br />D. Transporters Phona <br />7. Tran to 2 CompanyName 8. EPA IDNumber <br />E. State Transporter's l®(R v . <br />erI <br />/U'S <br />Ci V `V G l ! <br />F. t'raneporfers Phana ®. <br />9. Designated cility Name and Site Address 10. US EPA ID Number <br />G. State FacRhy's tO <br />SUM-KLEN (SAN )= INC. <br />IcIal 121519141 SL4131 <br />1021 Owym RwQ <br />H. P•ac!1ivs Phone <br />1-408-451-5000 <br />11. US OOT Description (including Proper Shipping Name, Hazard tacos, and ID Number? <br />2. Contoinera <br />13. Total <br />Quantity <br />Id. Unit <br />Wt/Yd <br />t. Waste Number <br />No. <br />I Type I <br />a• <br />State <br />EPA/Cither <br />INA <br />Nb' <br />fRi� Ty�M+11 idlr� Gd=4'r�� /V. d. e%. <br />State <br />A <br />g <br />Al Z / �� /w <br />f <br />a0 <br />1 JQI <br />P <br />EPAIOtho� <br />T <br />c. <br />Sroro <br />O <br />R <br />t <br />EPA/Other <br />d. <br />Slate <br />I <br />EPA/Other <br />J. Additional Deseri stions far Malarial& Listed Above <br />fills/7 <br />K. Handling Codes for Wastes Listed Above <br />e elx <br />a. b. <br />d. <br />a. <br />e. <br />I <br />15. Spada! fhtg hsrructions and Additional InFormaticn <br />24 Hour ngRes se Tel. No. CHEMC 1-800-424-9300 <br />110f ERG litrpm ve �9Fir Bill of Lading :56 7 9 <br />Sales Order <br />16. GENERATOR'S CERIIFICATtoN: 1 hereby declare that the contents of this consignment oro fully and accurately described above by proper shipping name and are classified, pocked, <br />marked, and labeled, and are in all respects in prepar condition For transport by highway according to applicable international and nalional government regulations. <br />IF I am a large quantigsnerator, I cartify that I have a program in place to reduce the volvme an® toxicity of waste generated to the degree 1 have determined to be economicali <br />practicable and that I erected the praeticalsie mathod of treatment, storage, or disposal currently available 'o me which minimizes the present and future threat to human heclX <br />and the environment; OR, R f am a small quantity generator, i have made e f ith effort to minimize my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />grin YP a"a <br />Month Day Year <br />V. Tr •error 1 Acknowled mentof"R.c,, *F Marials <br />.11 ef3 <br />T <br />A <br />Prin�/TypedNameSignet <br />re <br />Minih Day Year <br />p <br />Trona rte 2 Ac wle anent of Recoi l of Materials <br />R <br />ET <br />Printed/Typed ane <br />•. <br />Signaler <br />Month Day Year <br />/Vf <br />t o C) <br />i 9. Discrepancy 1ndicatitsn Space <br />F <br />A <br />C <br />t <br />L <br />F <br />20. foci ity Owner ar Q ermar Certiflmtian of receipt of hazardous materials covered bv this man IFes'except as noted in item 19. <br />T <br />Printed/TTypecl NomeAPSignatu ' <br />Msoedt Do,/GY's. <br />DTSC 6022A (,/99) D; 'H ` iC --TSC `+JITIUt< ;n Dgyg <br />EPA 6700-22 <br />til•.: I'1<r:tC� �. �, y.^,5 :: <br />