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UNIFORM HAZARDOUS 1. Gan-, US EPA ID No. Manifest 2. Information In the shaded areas <br /> �,� Document No. <br /> WASTE MANIFEST ,I �' f is not required by Federal law. <br /> 3. Generator's Name and Melling Address A. State Manifest Document Number <br /> UNIVERSAL RMLE CORP X87 8 <br /> p (� pF�y B. Slate Generator's ID <br /> 02709 <br /> 4. G011ereT6r's•PIIbfiA(8��s sTOCKTON, CA 952oti <br /> 5. Transporter t Company AN,amfe�tlntnn�4fAs� 0. US EPA ID Number C. Slate Transporter's ID = _� I .i _.j <br /> ROM L�T>�IYNA,tr L�.M1n'V"a.nlPlr Ns• Q A Di 0101 (41 4161216151 7 D. TrensPoner'e Phone <br /> 7. Transporter 2 Company Name 0. US EPA ID Number E. State Transporter's ID <br /> F. Transporter's Phone <br /> 9. Designated Facility Name and Site Addraea 10. US EPA ID Number G. Siete Facility's ID <br /> ROM CHBWAL CORPORATION C1 Al Di 010191415121815171 <br /> 2081 ft Road H. Facility's Phone <br /> East Palo Alto, CA 900 I G Aj D3 0 1019141512 61 617 418 3244-1638 n <br /> 12. Containers 13. Total 14. I. <br /> 11. US DO j Description(Including Proper Shipping Name,Hazard Claes,and ID Number) Quantity Unit Waste No, <br /> t No. Type Wt/Vol <br /> a. `y state r. <br /> 214N WASTE ACETONE SOLVENT (FLAMMABLE LIQUID) � ! ^'1 - ft �1 EPA/Other <br /> Hb' stat <br /> A <br /> T EPA/Other <br /> O <br /> R C. State <br /> EPA/Other <br /> 11 <br /> d' State <br /> EPA/Other <br /> J. Additional Descriptions for Materiels Listed Above K. Handling Code.for Wastes Listed Above <br /> MIXTURE DIP ACSTONEr CALCIUM SULFATE (FILLER) a. b. <br /> CELLQLOSE (FILLER) CALCIUM CARBONATE (FILLER) c. jQj d. <br /> SPCA (HARDNBR) <br /> 15. Special Handling Instructions and Additional Information <br /> Gloved, Gogailft and Prow" mthing. (CAUTION—FLAMMADLL) <br /> REFER TO ATTACKED <br /> 1e. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,pecked,marked,and labeled,and are In all respects in proper condition for transport by highway according to applicable international and I�, <br /> national government regulation.. <br /> If I am a large quantity y program p <br /> 9 c Y generator, that that 1 elect a ro rem ti lace to reduce Ile volume and toxicity of waste generated to the degree I have determined <br /> pr be economically practicable and that I have selected the practicable I m a s of(reantity g nerape,or disposal currently fouth effort <br /> to me which minimizes wast the <br /> gee rat and future threat to lumen health and the environment;OR,if I am e'smell quantity generator.I have made a good tette effort to minimize my waste <br /> generation and select the beet waste management method that Is available tp.gie$ntl that I can afford. 1. <br /> Printed/Typed Name Signature / / Month Day Year <br /> HOWIS A POTTS i041 111 log' <br /> T 17. Transporter / Acknowledgement of Receipt of Materiels f - -- <br /> R <br /> A Printed/Typed Name Slgnatur <br /> It Month Day Year i <br /> 9 <br /> I r� 'A ,L%'(, t/ � '� <br /> P F'.... <br /> O 18. Transporter 2 Acknowledgement of Receipt o Materials....., <br /> R Printed/Typed ed Name <br /> T YP �RiW�lure Month Day Year <br /> E <br /> 19. Discrepancy Indication Space j rA - , <br /> A 4- <br /> I 20. Facility Owner or Operator Certification of receipt of hazardous ahgfhiwiqlalcoverad by this manifest except as noted in Item 19. : <br /> T <br /> y Printed/Typed Name Signature Month Day Year <br /> J" 811nMGREGM EtLMN/RAY 80M t <br /> 8022 A(vee) Do Not Write Below This Line <br /> 8700-22 YELLOW: GENERATOR RETAINS <br /> 9-9e)Previous editions are obsolete. <br />