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State of California-Health and Welfare Agency Department of Health Services <br /> �. Form Approved OMB No.2050- 0039(Ezpirea 9 Toxic Substances Control Division <br /> print or type. (Form designed for use on efi 12-pitch typewriter). Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest 2. Page 1 <br /> WASTE MANIFEST Document No. Information in the shaded areas <br /> of is not required by Federal law. <br /> 3. Generator's Name and Meiling Address — ° ' A. State Manifest Document Number <br /> I <br /> f Newark-Sierra Paperboard Corp ,Tub :570q�?�� 714 <br /> 800 W. Church Street, Stockton, CA 95?g 3 R. State Generator's ID <br /> 4. Generator's Phone(,t, ) r, r, <br /> — h z l rd .. _. <br /> UD 50 Transporter 1 Company Name 6. US EPA ID Number C. 91stA ransp rter's <br /> i N <br /> D. Transporter's Phone OiQ - <br /> N 99 R f <br /> 7. Transpo er ompany Name 8. US EPA ID Number E. State Transporter's ID <br /> m01 1 1 1 1 1 F. Transporter's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> a Anderson Solid Waste <br /> 1870- C-vmbridc e Road, Anderson 96007 H. am ifY's Phone " ` <br /> iM Z C116-347-571 <br /> f( 12. Containers 13 Total L <br /> N 0 ID 11. US DOT Description(including Proper Shipping Name,Hazard Class,and Number) Quantity Unit Waste No. <br /> r7 Q No. Type Wt/Vol <br /> ZG a (RQ) Hazardous, Liubstance Solid, N.O.S. State_Jr <br /> N �_ E ORK-E, MA9188 (Asbestos Buildin, Material) EP <br /> � 3 E b. n P E2 0 � 1r <br /> R - s / State <br /> A <br /> ro T EPA/Other <br /> N O <br /> a R C. .. State <br /> m <br /> EPA/Other <br /> Wd. State <br /> Z <br /> W <br /> U EPA/Other <br /> w <br /> Z J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> O a. b. <br /> a <br /> C. d. <br /> J <br /> Z <br /> Z <br /> O <br /> f. 15. Special Handling Instructions and Additional Information <br /> Q <br /> Z <br /> Wdo not tweak. lmor cause dust. _raiJ bt@athi% dust. <br /> FURY SEPARATELY AND COM NT.TH REFUSE. <br /> J <br /> tl 18. <br /> J GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> J and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> Nnational government regulations. <br /> Cr 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 <br /> O to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> present and future threat to human health and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste <br /> U generation and select the beat waste management method that is available to me and that I can afford. <br /> Z _y i <br /> Printed/Typed Namebut 7 Signature Month .Day G"f <br /> it <br /> G E G <br /> bit T 17. Transporter 1 Acknowledgement of Receipt of Materials - <br /> R <br /> A Print <br /> < N yped Name / Sig netu i ,F Month' Day Year <br /> w S <br /> O p <br /> W O rens o Ackhowl tlge nt oT RecWat gf Materiels <br /> R Printed/Typed Name Signature T g Month Day Year <br /> O <br /> E <br /> 2 <br /> 19. Discrepancy Indication Space - <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T <br /> y Printed/Typed Name Signature Month Day Year <br /> DHS 8022 A(1/88) Do Not Write Below This Line <br /> EPA 8700-22 <br /> (Rev.9-88)Previous editions are obsolete. <br /> YELLOW: GENERATOR RETAINS <br />