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Stats of ifgNsio-Environmental Protection Agenry <br /> F a No.2050-0039(Ex ires 9.30• v <br /> OfSAtf p 91Q) 7>p 586 IDSfI'UCf100f(fD bQ� �4 1 -Department of Toxic Substances Control <br /> PI Form designed for use on elite( 2•pikhf tiler. eµ. <br /> Sacramento,California <br /> 1. Generator's US EPA ID Nq;, Manifest Document No. 2. Page 1 Information in the shaded areas <br /> .,NIFORM HAZARDOUS F rii not required by Federal law. <br /> WASTE MANIFEST C A D 0 6 8 8 4 5 2 5 413 $ R! at <br /> 3 PI <br /> Generator's Name anA i iZ <br /> Add�r�s�sNC ;fes g�•i Lit <br /> DSL9'A r . ± <br /> 818 S. STANISIAU3 STRIKIff <br /> in ti CA 95206 (209)948-2768 n4 . <br /> A. Generator's Phone r <br /> tV 5. Transporter 1 Company Name 6. US EPA ID Number <br /> CO <br /> 6 21ist CM'URY EW C AR 0000 5 803 ' ` <br /> 7. Transporter 2 Company Name 8. US EPA ID Number "d < <br /> V. 1 <br /> T) 9. Desi nated Fauli Name and Site Address 1 US EPA IQNumber <br /> U� BI I.�t30TOl AL, INC. �. . <br /> ry ce 20245 77TH AVE WM SOUTH • F <br /> *-0 KELT, WA 98032 WAD 9 9 1 2 8 1 7 6 7 <br /> .:. <br /> NJ <br /> Q <br /> 11, US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12.{ontainsrs 13. Total 14: Unit <br /> V No. T Quantity Wt/VOI <br /> Z RT WASTA CHRONIC ACID SOLUTION (CHROKIC ACID) 8 UKIT55 PGII <br /> ~ RQ0112) ERG(lia) C g <br /> ,r.. <br /> G / loll <br /> 1 G .. <br /> N E >f1 ` 0161 /l/0 <br /> o N R(f HAZARDOUS WASTI, SOLID, N.O.S. (F116) 9 KA3177 PGIII RQ(F116) <br /> co E RRG 171 <br /> R ) - . 13 A P <br /> A <br /> ® <br /> -.C d' <br /> us <br /> LU <br /> O 18 772 rfor est in <br /> ry h <br /> M94143-15 X146 Ila <br /> ti}¢ <br /> x <br /> Rb <br /> N` <br /> 15. Special Handling Instructions and Additional Information <br /> a 41AR PROPER PROTECTIVE CLOTHING. EKBRGINCY HISPOKSI PHONE (811) 567-7455. s <br /> Z .- <br /> W <br /> -ter _16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipring name and ars classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according fo applicable international apd notions'government regui4tions. <br /> J If I am a large quanti generator,I certify that 1 have a pr ram in place to reduce the volume and toxici of waste generated to the degree i have determined to be'economicall <br /> y pro y y <br /> H practicable and that I hove selected the Practicable method <br /> Tom <br /> storage,or disposal currently avant ble to me which minimizes the present and future threat to human health. <br /> and the environment,OR,if I am a small quantity generator,I have made a good faith effort to minimize myJwasfe gonarghon and• bssE;±etoste monagemant method that i; <br /> °C available to me and that I can afford. s : s <br /> O <br /> edNome <br /> Month y Y <br /> CD TR 17. Trans rter 1 Acknowledgement of Recei t of Materials <br /> ceA Printed T ed.Nome % Si na <br /> R ` ' g / r Month Day Year <br /> Og 18. Transporter 2 Acknowled ment of Receipt of Materials <br /> T Ppnted/Typed Name <br /> l` ' <br /> � .,,.:: ,.. nth.. <br /> _v o Day' Year <br /> sae E <br /> Ir ri <br /> F <br /> 1 Discrepancylndication pace <br /> Z <br /> T•,. <br /> — A <br /> w_._. <br /> L _ P <br /> ( 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered b this monife e`f os n i Item 19+:: <br /> T Pr�_,sid,/,Typecl Name Si naNre !-� r ° <br /> t ® ;_-"` Month" Day Year <br /> DO NOT,WRITE BELOW THIS41NE. <br /> caow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> DTSC 8022A (1/99) (Generators who.submit hozordou' 'waste for transport out of-state, <br /> EPA 8700-22 produce completed copy *l`this send to DTSC within 30 <br /> 9 <br />