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Stale of California—Emironmenlol Protection Agency # L 7 L ., <br /> Form Approved OMB No.2050-0039(Expires 9.30.991 See Instructions on bark�@�l. Departmenta Toxic subsro7hi.Control <br /> Please print or type. Form designed for use on elite(12-PA pewrlfer. Soaam�nlo,Culi�ornio <br /> 1. Genewlor's US EPA ID No. Manifest Document No. 2. Page 1 Informotion <br /> in the shaded.rens <br /> UNIFORM HAZARDOUS isnot required by Federal law. <br /> WASTE MANIFEST , �9 hS1012111 y 1 4 q of i. <br /> 3. Generator's Name and Moiling Address A. Shite Mannino Document Number ^ . <br /> i_7ETo'ERAL Na Ll. L <br /> ATTN. WADE BF.GUGHTO'N' S. State Ginsrmar's ID <br /> h ROY. 3002; LODI, CA .. L4..1wOb y� <br /> sD 4. Generator's Phone( •, 1 ^-{ 0':0 3 a"ll NG+ CONTAm sox 15 <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID(Rase .( <br /> h <br /> UNIVAR USA INC. D.Yraasp.rter',Phone - <br /> g cADo1a 91215151 71 a <br /> C? 71 Transporter 2 Company Name 8. US EPA ID Number E. Won,I romporters ID IReserved.l <br /> N� UNIVAR. USA INC. E-Tnimporter'sPhone 8 <br /> �Y-i CAR 010101 0141 7 n 9 23- 3?-714- <br /> V 9. Designated Facility Nome and Site Address 10. US EPA ID Number G.Smm F.01y's ID <br /> d DEM.Sxx(,IxERDOoxI IIA <br /> ?')Z2000 N. ALV4EDA STREET H. Fodlity',Phone <br /> Nes CCMPTON, CA 90222 CRD 0 810101113 3 5 2 310-53?-71J'0 <br /> 12. Contoinen13. Tarot 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. T Quanti Wt/Vol 6 Waste Nvmbar <br /> NZ a NON-RCRA HAZARDOUS b3ASTE, LIQUID" (ETHYLENE GLYC L, stbro <br /> RI= IPRCPYI..,ENE GLYCOL'} J EPA/04., <br /> 3 G D M wriNE <br /> gate <br /> o N It. <br /> m E EPA/Other <br /> 4 R <br /> A state <br /> O T <br /> O EPA/Other <br /> R <br /> W d. State <br /> Z <br /> W EPA/Other <br /> V <br /> w 'K. Handling Codes-or Wastes Listed Above <br /> 1. Additional bescripnom for Materials Listed Above <br /> .1n.= 40413 GYLCOL SOLUTION a:.. b. <br /> N <br /> Wd. <br /> 15. Special Handling Instructions and Additional Information WEAR APPROPRIATE PROT'El"T--VE SEAR WHEN HANDLING. <br /> O EMERGENCY CONTACT: CIM4TREC: 1-800•-424-9300. CALLER MUST IDENTIFY UNIVAR USA AS <br /> z SMIPPER. <br /> z <br /> W PLACARDS PROVIDED BY =A.RRIER/SHIPPER YES/NG DRIVER SIGNATURE <br /> X <br /> 16: GENERATOR'S CERTIFICATION: (hereby declare that contents of this conignment are fuIlyandaccuralalydewribedaboveby Propershippingnameandareclb.A.d,paclad, <br /> U " marked,and labeled,and are in all respects in proper condition for transport by highway according ro applicable international and national government regulation>. <br /> If I am a large quantiy generator,I certify that I have a proggram in place to reduce the volume and roxidy of wrote generated to the degree I have determined to be economicalH <br /> i pmdicable and that I hhave selected the practicable method of trwlmenp storage,or disposal currently available ro me which mi 'mizes the present and future threat ro human haandLs <br /> to and the environment;OR,if 1 om a snail quantiy generator,I have made o good faith effort to minima.my waste E.mnaloisand s lect the best waste management method that is <br /> oc available <br /> tomeand that l�can <br /> safford. <br /> 0 Pr J'Y!6 a (iL.v[.•e' r Sigmtu /'Z ,AsWtI1fiJ r'i}alJ �ar <br /> Z. T V. Trans otter I Acknowled ement of Recd t of Materials <br /> R Sin <br /> aNr a "Moyb., y0a earx` <br /> R Printed/Typedola <br /> P <br /> 0 18. Trans rter 2 Acknowled ement of Receipt of Meredith <br /> TPrinted/Typed Nam. Signature Month Day Year <br /> W [ <br /> � R <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> c <br /> 20. facilityOwner or operator Certification of receipt of hazardous materials covered 6 (his manifest exce t as noted in Item 19. <br /> T Printed/Typed Name Signal... Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR $ENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A(1/991 To: P.O. Box 400, Sacramento, CA 95812-0400 <br /> EPA 8700-22 <br />