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t(- of 41,fohn .a Environmental Frontal)Agency <br /> fQ APF)tetedI'll 2050-00391Ezpirei 9-30-491 _ _ SCE Inaructions on back of p-,e 6. r e Department of Toa;Sub" cer Control <br /> IfTo��Tlfi <br /> e. For dewgned for use on elite(12-pitch)ty 1� Sacramento,Cal f 1. oes US EPA ID o Manifest Document No. 2, age 1 Information in the shaded s <br /> A' M HAZARDOUS o regmred by Federal law. <br /> WASTEof <br /> enerator's Name and Mailing Address . A. State flani{est Docemenl Number <br /> RAL MILLS <br /> WALE BROUGHTON B. Slow Generator's ID 24573271 <br /> o OX 3OCZ ; LODI-, CA 9SZ411406 <br /> 4. Generator's Phone(?Dns 1 :}?4_7090 ENEP.GENCY'C4311TACT: BOX 1 <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. Slate Transporter's ID(Reserved.) <br /> ao UNIVAR: USA INC. D. Transporter's Phone <br /> $ v R. R lo 0 iri l) Is 13 1 6 13 ? 916-371-7500 <br /> _ 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.( <br /> 'bil.VAR USA . INC. . - p C. .F.'Trainporler's Phone . . <br /> C A D b _ 5 5 7 6 404-435 8?C <br /> 6L 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> 5EF1EId'NG/ElD0014 C <br /> Za, OOO IT. ALAMEDA STREET H. Facility's Phone <br /> OMPTON, CA SOZZZi " r, 310-537-7100 <br /> I1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> U No. FTy Quantity Wt/Vol I. Waste Number <br /> Z a:TON—RCRA HAZARDGUS WASTE , 'LIQUID i:ETHYLENE aLYC( L , 51a1a <br /> z <br /> FROPYLENE GLYCOL ) EPA/Other <br /> 3 G > <br /> E b <br /> act <br /> Slat. <br /> cs to E THIS WASTE STREAM HAS BEEN OUALIFIEb EPA/Othe, <br /> aR FOR RECYCLING ITREATMENT AT THE <br /> T cDOMENNOINEROOON FACILITY IN COMPTW state <br /> R CALIFORNIA.THIS FACILITY HAS THE NECE EPA/Other <br /> PERMITS TO RECEIVE YOUR WASTE WIMERAIM!54V <br /> State <br /> Z d. OUALIFIEII OUR VA NUMBER IS CATO80013N14 EPA/O her <br /> U <br /> W <br /> h J. Additional Descriptions for Materials listed Above K. Handling Codes for Wastes Listed Above <br /> O 11a. 240413 GYLCOL SOLUTION <br /> N <br /> W <br /> a[ c. d. <br /> Qti <br /> 0 15. Special Handling Instructions and Additionalln{ormatian 'WEAR APPROPRIAT?-PROTECTIVE GEAR WfTEN SANDLI:4G. <br /> tR IaEEGENCY CONTACT: CHEMTREC; 1-900-4L4-4300 . CALLER MUST TOENTIFY UINIVAR JSA „AS <br /> Z SHIPPER. <br /> W PLACARDS PROVIDED BY CARRIER' SHIPPER YES/1IL DRTVE'R SIGN.4TU2E <br /> x <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate)y described above by proper hipring name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and notion. government mons. <br /> If I am a large quantity generator, certify that have a program in place to reduce the volume and toaiciy of waste generated to the degree I have determined to be economicallyy <br /> i practicable and that have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human heallh <br /> tA, and the environment;OR,if 1 am a smaquantity generator,I have made a good faith effort to minimize my waste generation and elect the best waste management method that is <br /> d' available to me and that I can afford. _ <br /> Or P ble y Name Signa('a on Day Yea <br /> Z I It <br /> D AQ /V',' <br /> . Trans oder 1 Ac no led a ant o{Rec ials ' <br /> Print TypeSign p Morin - Day Ye <br /> 'r <br /> A <br /> S. <br /> ssT p <br /> Id. :, B IB rd hart ckna 'edga=F,*ftZ6iptot Molerid s' <br /> d 8 oture Month Day Year <br /> -7 Pr nted/T ed IN .g F- <br /> N [ f ♦ ,sem 7 4.- <br /> A N V <br /> U 19, Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest eats 1 a ted in Itieli <br /> T nmd/Typed Name '1 Signature _ / Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS l <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A()/991 (Generators who submit hazardous waste for transport out-of-state, <br /> produce completed copy of this copy and send to DTSC within 30 days.) <br /> EPA 8700-22 <br />