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State of r'.alifornia—Environmental Protection Agency <br /> Fgrm Approved OMB No.2050-0039(Enpires;A-;9,Qr99} SEB Instructions on back Of 994179 Department of Toxic Substances Control <br /> Pleura print or type. Form designed for use an @fife(12-plkh) Sacramento,California <br /> I. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> Is 6 <br /> UNIFORM HAZARDOUS C A Is 0 0 0 2 2 1 0 4 5 6 8 3 2 is not required by Federal low. <br /> WASTE MANIFEST of <br /> 3. ,AtGee� e� lress A. $Iola Manifest Document Number r� q <br /> 1010 INOX3bzRIAL DPIV..E 2 4 7 14 61 5 <br /> c SrOCWMN CA 95206 (209)963-8298 B. State Generator's ID <br /> 4. Generator's Phone I I <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transport./,ID[Reserved:] <br /> " <br /> 21st cAI30001 6 401 <br /> m D. Transporlar',:Ahone (879)748-3040 <br /> O <br /> O <br /> b? 7. Transporter 2 Company Name B. US EPA ID Number E. State Transporter',ID[Reserved.] <br /> �J F. Transporter's Phone <br /> p" 92�ena ets�li�f+l�pie141te Address 10. US EPA 10 Number G. State Facility's ID <br /> Q2095 Newlands lir. East HI <br /> . Facility's <br /> Oc Phoma <br /> �O Fernley, NII 89408 V (775) 575-2760 <br /> f'Q 12. Container �.:13. Total 14. Unit <br /> U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol 1. Waste Number <br /> VZ Xa. WASTE CORROSIVE LIQUID, BASIC, INORGANIC, R.O.S. (POTASSIUM ':stare. 122 <br /> _- B10101I0,50DDIUM GLUCONATE) 8 UN3266 PGI ERG(154) D EPA/Other <br /> 3 G t $ If v o <br /> o N X6. WASTE CALCIUM HYPOCRLCRITE, HYDRATED 5.1 U12888 PGII 62G(148) (j State <br /> 13001 <br /> N R .-43==N 'EPA/Other <br /> o T Xa WASTE SODIUM HYDROXIDE SOLUTION 8 U1824 PGIII ERG(154) xJ State 122 <br /> W R + D G EPA/Other <br /> Xd NOM-RCBA HAZARDOUS WASTE SOLID (ABSORBENT CONTAMINATED WITH 1 / State223 <br /> Z <br /> V DIESEL/OPL) <br /> P EPA/Other <br /> C} n <br /> 0101( <br /> Z al GLUCOMATE - WAT12-3 (11) IF) 140116-l# WT82 K. Handling code Far WastesListed Above <br /> 0 CALCIUM HYPOCHLORITE CLEAN UP DEBRIS - INCI1 (1) c) 348136-88 - 500I1111 0. b. <br /> HYDROXIDE - WAT82-3 (6) d� 348112-11 - ABS093ERT CONTAMINATED WITH DIESEL AND <br /> 00114 - 1,211P11 (4) <br /> Z �f Fr: ks:uf� d. <br /> Z 15. 5@tial Handling lnstru lions and Additional Information <br /> WLAB PROPER PROTECTIVE CLOTHING. EHER GENCT RESPONSE PHONE (886) 567-7455. <br /> Z <br /> x <br /> -s 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper ship ing name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nationaPgomi-nmenl regulations. <br /> If I am a large quantiy gwerator,I carlify that I have a pro ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be aconomicollyy <br /> a_ practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and Future threat to human heal <br /> tb <br /> N <br /> oc and the environment;.and at I if I am a small quantity generator,I have made a goad faith effort to minimize my waste generation and select the best waste management method That is <br /> O available ro ma and that I can afford. <br /> } Printed/Tied!Name Signgtyre F Montt Day Year <br /> Z <br /> w T 17. Trans Diner)Acknowled ement of Isnasigotot Materials <br /> A Print Typed Nam ignature Montt Day Year <br /> w R '� // <br /> w 5 1,.. <br /> U. 0 1711 Transporter 2 Acknowledgement of Receipt of Materials L' <br /> O R Prinlad/Typed Nome Signator@ Month Day Year <br /> T <br /> H A ,s <br /> (aJ <br /> F 19. Discrepancy Indication Space <br /> Z A <br /> C \ <br /> 20. Facili Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A I1/991 Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 400, Sacramento, CA OS812-0400 <br />