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jgdte of Calito(nia—Endrpnma I Protection Agency
<br /> orm App; OMB No50-0039(Expires 9-3099) - See Instructions On back OF page 6. - Department of Toxic Substances Cam,,
<br /> i, Plooseoinf or type. Form designe4far use on elint(f 2-pi +ewrib[. Sacramento,California
<br /> W ' I Generator's US EPA ID No. Manifest Documen ..0 2. Page 1 Information in the shaded areas
<br /> UNIFORM HAZARDOUS is not required by Federal law.
<br /> WASTE MANIFEST 2 5 g of 1
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<br /> 3. Generator's Name and Moiling
<br /> Address A. Stote Manifest Document Number 23812535
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<br /> o 400 K)USTR54L PARK DRWE MAN Ih A,(;A. 9633f S. Stote Generofo/s TD
<br /> n4. Generator's Phone I ^�`)-li2 Z3r,, Ai'h'l At4MlA) KA
<br /> r S. Transporter I Company Name 6. US EPA ID Number C. State Transporter's ID.[Reserved.1 -
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<br /> T�2anDS I=3WIrWMlerital SetYM:esFlo, yv i-.�,� r'. ..-Transported.Phmss__-.___._ .,R. � 574.
<br /> 7. Transporter 2 Comliany Name 8. US EPA ID Number E. State Tnspipadm'e ID IReserved:l R V
<br /> Q ' E_ Transparlsi s,Phbne
<br /> V Q ip.1 d.Focility Namq a d Site Address 10. US EPA ID Number G.5- e s ('1
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<br /> Z 3M F. 2] th- St. H: F cihys Phone
<br /> to Veman, Ca. 9DO23 T 0181010 3 3 11 323-268-5056
<br /> y7 U 11. US DOT Description[including Proper Shipping Name,Hazard Class,and ID Number)IV I2. Containers 13. Total I4. Unit
<br /> No. Type Quantity Wt/Vol 1. Waste Number
<br /> WASTF- AMMONIA ,SOLUTION, 9,UN2762,PGIII r state tzz
<br /> 3 G ,LAB PACK) ERG'00 # 1 Q 1 // r I EPA/gher �
<br /> N VMSTE f-TT-ANOLAMINE 301 TTION, 6,UN2491, 11 Y St`' 122r R (LAS PACK) ERGOD 9153 O f 17 T ( E °th" Dxa
<br /> T Waste Co(Tosive Liquids, N.O.-O., 9, UN1760,PC Sto'e
<br /> R (surfactants, sodium hydroxide) ERC7'00 #154 1 114/06er DX2
<br /> NON - RCRA HAZARM_ JS WASTE LIQUID stole
<br /> Z ( soap, oil ) ERG'00#171EPA oto. .
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<br /> J.�Additionolpeseri fiom for Matlls sledp�,yvpn �'C7l K. Handling Codes for Wmtes Listed Above
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<br /> 0� an.[Information
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<br /> Z 24 HR. EMERGENCY CONTACT` 91&371-5747 deb# PPt )�fteTL
<br /> W 400 INDUSTRIAL PAW,DRIVE, MANTE:C:A, CA., f
<br /> 16. GENERATOR'S CERTIFICATION: Ih...by tied...that the contents of this consignmentarefully and aca.ralely described above by proper shippi ng name and are classified,packed,
<br /> Vmarked,and labeled,and are in oil respects in proper condition for transport by highway according to applicable international and national government regulations.
<br /> J IF I am a large quantiq generator,I certify the I have a Mogi m in place to reduce the volume and toxicit,of waste generated to the degree I have determined to be economlcoll
<br /> d practicable and that I have selected the procticoble method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human heolM
<br /> and the environment;OR,if I am a small quantity generator,I have made a cod faith off minimize m to nerotioo and select the best waste management method that is
<br /> 9 N Be^ 9 y was ge g
<br /> z available to in.and that 1 can afford.
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<br /> r Prinhd/Ty ed Nama Sign yre 1 Mont Day Year
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<br /> m T 17. T.n,p,r 1 Acknowled'emeni of Rwei t of M.N,,..s
<br /> NPrinbdame ©`�rIQ ��� Sigrwtu - v^ OMonth /Day Year
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<br /> u.-0 18. Transporter 2 Acknowleti emem of Receipt of Materials OK EWIRONMENTAL RGILITY 11111 us
<br /> O i Printed/Typed Name - SignaturoANGELES, CALIFORNIA HAS THE Mantlt Day Year
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<br /> (aj F 19. Discrepancy Indication Space y
<br /> Z A ' WASTE STREAM AS QUALIFIED OUR EPA
<br /> IS CAT080033681
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<br /> 1 20. r or a an o e e t of b rdws matodale covered xce t as nets n Item 19.
<br /> T Pri /T signature
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<br /> DO NOT WRITE BELOW THIS LINE.
<br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS.
<br /> DISC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-slate,
<br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)
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