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Slate of Protection Agency �7 b 7,1A/A D��E2/I <br /> Fdrm Appraratf OMB No.2050-0039{Ex Puts 9-30-99) See Instructions On back�age 6. p ant osu Substance <br /> Please print or typo. Farm designed for use on elite 112-pi pewritcr. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Pagel In formation in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST CIAJ Ll 0 10 101217131617111 5 1 3 1 9 13 19 of 2 <br /> Genera r s Noma a d� Mallin Id £y A. State Manifest Document Number&t�E 228539'4 <br /> 1905 Aatan Aaanua <br /> o Carlsbad, CA 92008 B. State Generator's ID <br /> vase 4. Generator's Phone 1 650 1 525-2100 <br /> N 5. Transporter I Company Name 6.♦USS EP ID Number �� �� C. State Transporte/s ID(Reserved.) <br /> u T—ND <br /> D. TcaropwteYs Phone <br /> 0 <br /> Pollution Control Industries (916)351-098D <br /> cD 7. Transporter 2 Company Nome 8. US EPA ID Number E. State Trans sorter's ID Reserved.) <br /> Q <br /> U F. Transporter's Phone <br /> 1 S � Z Z � �° 1 R 2 <br /> l.J <br /> P. Designated Facilil� ams and Site Address 10. US EPA ID Number G. SIM.Facility's ID <br /> Ch¢ Pollution Control Indu3trie5 <br /> Ln z 4343 Kennedy Ave H. Facility's Phone <br /> 00W0 East Chicago, IN 46312 IIINIDJOIDJOIBI416191413 (219)397-3951 <br /> Q 11. US DOT Description(including Proper Shipping Nome,Hazard Classand ID Number) 12. Containers 13. Total 14. Unit <br /> Oj U No., T pe Quantity Wt/Vol 1. Waste Number <br /> Z a. RQ, waste flammable liquids, n_o_s ?.z Slate <br /> 1 L- (methanol, toluene) , 3, UN1993, PGII (RQ=DO01) 343 <br /> 3 G P EPA/Other- <br /> D001 <br /> o N b. waste corrosive liquid, acidic, inorganic, Stow <br /> f°oa F n,o_s T 8. 79 <br /> r UN3264, PG.11 P �Dr002 r.".. <br /> ' A r waste corrosive liquids, basic,inorg-eu state <br /> o i 122 <br /> O n.o_s (sodium hydroxide, sodium hypochlorite) , <br /> er <br /> R 8, U=266, P31.1 J P EPA/Ot DD02. <br /> Fd, pestics es, aqui s, toxic, n_o_s idliavI State .. <br /> Z <br /> v Nd7 / P hNONE <br /> W <br /> sn J. AdW I Descrt tions ter Materials listed Above K. Handling fades for Wastes Listed Above <br /> Z a) W33 (k'�003,. F005 D035) bj-W3�5—cc)kh 7 2-" a 6 <br /> o a) 7X 'A X 150 <br /> W b) a)---- <br /> m <br /> a <br /> 0 3S. S£iiG$$�1a2.Elandli�g Ig_ntTuctti `&�ne Int ) <br /> // 4154 d) EM01:5 5 �'T S-� o l I <br /> 24 HOUR EMERGENCY RESPONSE (800) 388-1242 <br /> sZ, Site Address: 701 D°Arcy Pkwy, Lathrop, CA, 95330 <br /> Confirmation# Proposal#23554 Tcuck# !(J�/ <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and occuraroly,described above by proper shipping name and are classified,packed, <br /> Umarked,and labeled,and ore in olllrespects in proper eondil;on for transport y highway according to applicable international and national government regulations. <br /> If I am a large quantiq generator,I certify that I have a p ogram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> d practicable and that I h ve selected the practicable method a treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am o smaquantity generator,I hove made o goad faith effort to minimize my waste generation and select the best waste management method that is <br /> a, available to me and that I con afford. <br /> OPrinted/T d Nama` ' Signature �t Manlh Day Yea <br /> z Oc? V iC A !/ 1 I `f o <br /> Z7 17. Transporter 1 Ackn ledgement of Receipt of Materials <br /> Nw Printed/Typed Name Si gpa onlh Day Yea <br /> w 5 -ILr c <br /> a ,D 8. Trans orler 2 Acknowledgement of Kocelpt of Materials <br /> O Printed ma Si / Month Do yea <br /> - V9. Discrepancy Indication Space <br /> Z <br /> C <br /> I allE <br /> 20. Facility Owner or Ocerator Cadibc doof recei f of hazardous materials cov this manifest exce t as noted in Item 9. <br /> T cot / a ign u Month Da Yeai <br /> Y <br /> DO NOi WRITE BELO T 11 LINI. <br /> White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 877000--22 <br /> DISC 0 11/991 To: P.O. Box 3000, Sacramento, CA 95812 <br />