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State of California—Environmental Protection Agency - ` � ORDER :.; 298873 Y <br />Form roved OMB No. 2050-0039 (Expires See Instructions on back f age 6. <br />APP ( P I 1& � 9 Department of Tozlc Substances Contra <br />Please print or type. Form designed kr use on elite (IT-pif tribe SacromenlAali64a <br />�Q <br />�U <br />coz <br />NryJ�O <br />4...lJ <br />iY#U <br />Nz_ <br />x <br />3 <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) Yellow: 3ENERATOR RETAINS <br />EPA 8700-22 <br />UNIFORM HAZARDOUS Gen.ratar's US EPA ID No. Manifest Documo. an 2. Page 1 Information in the shaded areas <br />is not required by Federal law. <br />71111111 - <br />WASTE MANIFEST -I -1 -1 �1 � -I -1 �I `I of ' <br />3. Generators Nm <br />ae and Mailing Address A. Stale Manifest Document Number <br />DELICATO VTIN 7�Rrt, x 238263 <br />^.1117. S H�dY 35� B. Slats Generaror's ID <br />L ''A 95,535 <br />Generaror's Phone j it P SSk BffC CO3SaCS: SQY 15 <br />5. Transporter I Company Name 6. US EPA ID Number <br />C. Stab Transporters ID Reseryed.] <br />D. TrsrsporlWs Phone <br />_ <br />' 91F-_'�� 'Ci;f <br />7. Transporter 2 Company Name 8. US EPA IDINumber <br />E. Slate Transporters ID Reserved.] <br />F. Transporters Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. Slate Facility's ID <br />POLLUTION CONTROL -:;n'i"TF-IE S <br />9343 KENREDY AVENUE <br />H. Facility. Phone <br />U.0T ;;aTC:.:d3, IN a6:;1 <br />TI r ;, dA d 4 A219-391-3951 <br />Hazard Class, and ID Number <br />11. UB DOT Description ]including Proper Shipping Name, ) <br />12. Containers <br />13. Total <br />Quantity <br />14. Unit <br />WI/Vol <br />I. Waste Number <br />No. <br />Type <br />a. WASTE METHYL ETHYL XZT;-,N� <br />sorts <br />3, UN1193, PG II, (EPA 010-- Du:,S FUU5', '(ERG 1213) <br />214 <br />EPA/Other <br />G. <br />24 <br />pool <br />E <br />N <br />, - (t}'; <br />.. <br />state <br />E <br />R <br />Ei,214 <br />_ - - _ r o <br />i <br />EPA/Olher <br />y <br />A <br />T <br />c. NON R SA HAZ],!-=COU P]AS'IE LIQUID <br />stats <br />p <br />(DIPHEHYLi�THANE DIISia._:<in E„. <br />III <br />EPA/Other <br />R <br />` <br />i4 <br />d. NOH-RCRA HAZARDOUS WASTE L-I0U11, <br />slats <br />. - DT •..RLORO-1- FL:K•r(:.`'17iT-:•,f� <br />EPA/Other <br />♦ <br />L <br />C M <br />J. Additional Desrkiplions for Materials Listed Above <br />K. HandliW6 Codes For Wastes <br />Listed Above <br />11.a. 02110311 T E'ui NE <br />.J <br />a. <br />b. <br />—RETY <br />y / <br />11c. 03100285LS ISO :',r ,= ;rtAIT A <br />a, <br />d. <br />ltd. 03100286LS RESIN PART B <br />15. Special Handling Instructions and Additional Information WEAR APPROPRIATE PROTECTIVE GEAR WHEN HANDLING. <br />ETtERGENCY CONTACT: Ci J't?Er; __..nr`_,; _930U. C:+ Lr . MUST IDENTIFY UNIVAR USA AS <br />SHIPPF_.R.f' <br />PLACARDS' PRn-.1-gr, ^ _ - .c,,,F.R/SHIPPER `-ES/NO DRIVER SIGNATURE <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 are classified, packed, <br />marked, and labeled, and ore in all respects in proper condition for from port by highway according to applicable international and national government regulations. <br />If I am a large quontiy generator, I certify that I have a program in place to reduce the volume and tonicity of wants generated to the degree I have determined to be economical] y <br />treatment, disposal currently available to me which minimizes the and future threat to human health <br />practicable and that ]lave selected the practicable method o storage, or present <br />and the environment; OR, if I am a smaquantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br />available to me and that can afford. <br />"TYear <br />PrindNama <br />SignaNrP�� <br />Mon <br />G L <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />APrinted/ <br />T <br />Ped Nam <br />All ��.11 <br />Signature % /r , <br />,rel 1;' /, /7 <br />6f <br />Month Day Year <br />0 <br />18. 1fonspornsr 2 Acknowledgement of Receipt of Materials <br />T <br />Printed/Typed No.. <br />Signature ;f <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />20. Facili Owner or Operator Certification of recei t of hazardous materials <br />covered by this manifest except as noted in Item 19. <br />T <br />Printsd/Typed Name <br />Signature <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) Yellow: 3ENERATOR RETAINS <br />EPA 8700-22 <br />