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r <br /> - Stalasel krpi, 050-l Protactirm Agency <br /> rr <br /> OMB RO30-0039(Espim 9-30-91) S!! IIIffFYC}IOOf OII back-0 79! b. . Department of Toxic Substancesi.Central <br /> , -- -fodesignedlorbseonefih(12p'Iwriter. SocremeMo.Cal'fomlaroroh US EPA DNo. Manifest Document No, 2. Page 1 Informatian in the shaded areaUNIFORM HAZARDOUS it notrequired by Federal low. <br /> WASTE MANIFEST 0 0 0 of Geneins is Name and Mailing Address <br /> Advanced Metal- Plating <br /> n 4421 Gianneeohinl Lane, Stockton, CA 95206 <br /> 4. Generators Phone (209 982-1104 <br /> 3. Transporter 1 Company Name 6,US EPAJD,Nu;nbbr <br /> 219t Century Frff -r4fV1-6j 9181018191 5151!38 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> _Q <br /> U <br /> col 9, Designaled Facility Name and Site Address 10, US EPA ID Number <br /> 21St Century EMI <br /> 2095 Newlands Drive, Fast <br /> Fernley, NV 89408 1 NI V DI 9181 0181915131311 <br /> 11. US DOT Deudptien(including Proper Shipping Name,Hazard Class,and ID Number) 12. C.Virwn 13.Total 14. Unit <br /> No. T Ouced' Wt/Vol <br /> L RQ, Hatardous`Waste`Solid, N.O,S.,' 4, NA 3077E ! /� q `. <br /> m3 PG III,(Hydroxide Sludge) <br /> 006 17 1 0 <br /> sE <br /> i m .N- b•c4 It <br /> . <br /> E <br /> A i <br /> A <br /> T c. <br /> °P 0 <br /> z t <br /> d. <br /> W . <br /> U r <br /> W { <br /> C � <br /> J <br /> Z <br /> 0 15. Special Handling Irntmetiwrs and Additional Information <br /> a wear <br /> 3P�tective clothing as required 24 Hour FSTEergetcy Phone: 800-648-9931 <br /> Z rational Response Center,: 800-424-8802 <br /> 3: <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, <br /> Q pocked,marked,and labeled,and the in all respects in proper condbim for transport by highway according to applicable international and notional government regulations. ' <br /> V <br /> J If I am a large quamity generator,.Lcerfify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I hove determined to be <br /> em practicable and.that have selected the practicable method of treatment,storage,or disposal currently ovoiloble to me which minimizes the presets and fuwre <br /> Nan heahh and the srvironmenb OR,H I am a small quantity ge r, I have mode a good fa' eRorf to minimize my waste generation and select the best <br /> na emeM method that is available to me and that I can afford. <br /> QPdnletl/ yped Nome Sig re 'Month Day Year <br /> Z V. 177.TTt nnys�o`rtder 1 mA�/jcjknowled emeM of Reeei t of <br /> Materials <br /> 010c SPf 6 <br /> 0 a P!/s lellp'\ Na shf <br /> M s �/ <br /> w r <br /> $ O 18. Baia r 2 Acknowled emeM of Recer t of M rials <br /> LL� r - Pdr. d/Typed Name Signature Month Day Year - <br /> O t <br /> R <br /> W 19. Discrepancy Indication Space <br /> VIF <br /> A <br /> Z C <br /> J <br /> L <br /> 20. Facility Owner or Oversdor Certifrcatian of ..lot of hazardous materials coorere this manifest except os n Item 19. <br /> 'TJY d/Typed Name Sign re Month Day Year i <br /> agDO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO.GENERATOR,WRF11N 30 DAYS. <br /> DTSC.80,i2A (9/93) (Generators who submit hazmdour ware for transport asst-of-dale <br /> EPA 87OD-22 produce completed copy of this copy and send to DTSC within 30 <br />