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_ Sate ol�elifomio—Environmmfol Prosection Agency <br /> Form Approved OMB No.205D-0039(Expires 9-30-94) See Instructions on bac page 6. Department of Toxic Substances Comr, <br /> leau print or type. Farm designed for uu on of m(12-pftw 1ypewrier. ...i Sacramento,CaBemia <br /> UNIFORM HAZARDOUS I. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST c A 0 0 0 0 5 9 0 6 5 3 14 9 (o1 / a1 1 <br /> 3. Generator's Name and Mailing Address A. State Mon;fest Document Numb,, <br /> Advanced Metal Plating 9.514 4 9 61 <br /> U') 4421 Giannecchini Lane, Stockton, CA 95206 B State Generator,ID ?, , <br /> n <br /> N 4. Generator's Phone (209) 982-1104 <br /> S. Transporter 1 Company Name <br /> 6. US EPA ID Number C. Store Tramparfers ID )� / <br /> 21st Century EMI <br /> N V D 9 8 0 8 9 5 3 3 8 D. Transp.0.r's Phan` 800-648-9931 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State,Transporter's ID <br /> Qi <br /> U <br /> co F. Transpbrler's Phone, <br /> co Q 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> W 21st Century EMI I 61 41 <br /> �0 2095 Newlands Drive, Fast H Foaly,Phone <br /> ;t a Fernley, NV 89408 INIVID191810181915 313181 800'6x48=9931 <br /> V 12. Containers 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. T QuantityWt/Vol 1. Waste Number <br /> Ln Z <br /> p; � a'RQ, Hazardous Waste Solid, N.O.S., 9, NA 3077, S'°" 171 <br /> 3 G PG III, (Hydroxide Sludge) X LX g X Sod EPA/Other*FO06 <br /> sate <br /> E Isstate <br /> ff-f+ Amc Lv+SreSoIfii n, c � �7 /)t3v'77 _ 1 "T <br /> R P4 Ul F �>�FaRoall� S(uat e) X X �{ 1- X 1 0 0 P EPA/a tio�v <br /> Q T c- State <br /> OP <br /> R EPA/Other <br /> Zd, state <br /> w <br /> U EPA/Other <br /> 111 <br /> J. Additional Descriptions far Moferiols listed Above '..K Hand Cod"for WaNn Used-Above <br /> i N 4Profile M95-184 * 'D007 <br /> w pp <br /> a <br /> APPt#: <br /> Z 15. Special Handling Instructions and Additional Information <br /> Wear Protective clothing as required 24 Hour Emergency Phone: 800-648-9931 <br /> Z <br /> = II2G #31 Ily+b National Response center: 800-424-8802 <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 aro classified, <br /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according has applicable imemationat and national government regulations. <br /> U <br /> If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be <br /> economically predicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> o_ threat to human health and the environment;OR, if I am a small quantity generator. I have made a good fair,effort to minimae my wase generation and select the best <br /> N waste management method that is available to me and that I can afford. <br /> C4 P' ed/Typed Name Sig re , Month Day Year <br /> o d D y <br /> V y e <br /> Z R 17. Transporter 7 Ackrrowled emenf o!Recei of Ma rials <br /> W A Prin egT�Ped Name Sigssaere Mash Day Year <br /> Cc AA'S !�, a loll 0 <br /> a 18. Trans rter 2 Acknowledgement of Receipt of Materials <br /> w t Primed/Typed Name Signature Month Day Year <br /> 0 t <br /> i � t <br /> sty 19. Discrepancy Indication Space <br /> N F <br /> U A <br /> I z C <br /> L <br /> 20. Facility Owner or eraor Certification of receipt of hazardous materials vexed b this manifest e e t oa Lem 19. <br /> t. T /Typed Name Sig m March Day Year <br /> y <br /> O, <br /> DO NOT WRITE BELOW'ftfrS LINE. <br /> 22A (9/93) Whie, TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DISC 80 <br /> I EPA 87022A To, P.O. Box 3000, Sacramento, CA 95812 <br />