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Stare of California—Environmental Protection Agency '• - <br /> Form Approvedpires 9-30-99) 'QS <br /> QMB Pb.2050-�39(Ex8 <br /> P . Department of Toxic Substances Contra <br /> -/' lease print or ! Form designed for us -pitc e on slits f 12 iMr. 7 r ? <br /> Sacramento,California <br /> UNIFORM HAZARDOUS I•,Generators US EPA ID No. AAanifedDocument o. Information in tho X*-d arena <br /> « WASTE MANIFEST - is not required by Federal law. <br /> 3. Generator's Name and Mailing Address 21 <br /> IXVTA PLATING, INC. d r < <br /> 81.8 S. STrANISLAUS 011MT �< ;; ,, <br /> h 4. Generator's Phone( j°d a r x <br /> t\ a i.' ZZ55 <br /> CV 5. Transporter 1 Company Name US E <br /> h 6. PA ID Number <br /> CP <br /> 1s y <br /> O <br /> o - <br /> '; <br /> 7. Transporter 2 Company Name 8. US EPA W Number <br /> r�s 9. Designated Facility Name and Site Address '` s f•r <br /> y 10. US EPA ID Number <br /> Q <br /> 302 <br /> 21st Century EMI � <br /> O 2CI95 Newlands Dr. Fast <br /> J <br /> -V V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 3• iners 13. <br /> _Z a. <br /> No. Type Quantity Wt/Vol Number <br /> Zit T <br /> 3 G FtV bhI'ii wUtukl% Ai ill SUm9TIGlf b 0HI745 PGII IQ(08821 KRG(154) <br /> E b. , AZ7 G : <br /> 'o N <br /> 00 <br /> co E ftt) :�8AI000S PASTS, SOLIl7, 1.0.5, (1`816) 9 1A3177 PGIII IQ(F/16) <br /> � <br /> A <br /> . 31G 17I <br /> o T C. 0 3 (® o LO r4Y1, <br /> 000 O <br /> R <br /> of <br /> d. ' <br /> Z <br /> W <br /> W FI'A/Ot ut <br /> V) J. Additional Descriptions for Materials Listed Above z(e <br /> Z a <br /> N a) 339966-11 0#17 - CUOIIIC ACID - 1AT14-1 (1) b1 t9t1t3�i3' <br /> "' - STAB132 <br /> ( ) <br /> Q 15. Special Handling Instructions and Additional Information ` .X "" <br /> 1`01 24 HNI RMORCT ISS S8, CALL (323) 776-6233 <br /> Z #W PkOPEk PROTECTIVE CLOTHIAG, CIEYGEICY IBSPOMSI IiI (881) 648-9931 (7751 $75-2777. <br /> W <br /> -J+ 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 by highway according to applicable internationa and national <br /> government regulations. <br /> W-' If I am a large quantity generator,I certify that I have a proram in place to reduce the volume and toxicity of wash generated to the degree I have determined to be economically <br /> practtheicable and that 1 hove selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the ppresent and future threat to human heahh <br /> and ab environment; at I if I am a small quantity generator,1 have mode a good faith effort b minimize my waste generation and seled.the best waste management method that is <br /> o available to me and that I can afford. <br /> } -PPiled Typed Nome $i nature <br /> W )P Month Dox Year <br /> (, 8 17. Trans rter l Acknowled emenf of Recei t of Materials ✓ <br /> RA Printed/Typed Name <br /> Signature <br /> $ r�. <br /> w P f d k .r Month Day Year <br /> O0 18. Tran art--2 Acknowled emenf of Recei f of Materials ® .3 dr fi d <br /> T Printed/Typed Nome <br /> H <br /> E Signature Month Da <br /> Q R y Year <br /> V F 19. Discrepancy Indication Space <br /> ZA �•� .-..r_ <br /> C <br /> .. .t <br /> L <br /> I 20. Fa6h Owner or Operator Certification of recei t of hazardous materials covered Phis manifest ex e I enoted'n <br /> T Printed/Typed Name $ignatyfs <br /> Y Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> [NDS THIS COPY TO GENERATOR WITHIN 30 DAYS, <br /> DISC 022A(1/991 motors who ;u6mit hazardous waste for transport out-ofh <br /> - ole, <br /> EPA 87700-22 cc� � ' <br /> ,,y of this copy and send fo DISC within 30 uoy;j <br />