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'Z' ' .,,t E MANIFEST ��+ h �? 1 6 b 16is not requiredbyregererraw. <br /> �sa� lnn_t4In —T L <br /> r'.,enerstor's Name end Meiling Address 'ate Menilesl Document Number <br /> .w <br /> UNIVERSAL RUNDLE ._,.P #87 <br /> P 0 BOX 6895 STOCKTON, CA 95206 B. State Generator's ID ' rJ <br /> 4. Generator's Phone(109) 982^0600 <br /> S. Transporter 1 Company Nemnennev��.s Y•�u� U. A t+ U�1S EPA r.I`D Numaeber C. Stele Treneporter's ID 1 <br /> m eyOMIC C.H WAr C ii r4IOnA ION `� A 5I I' () ,f! 4 6 �i 0 15 �r D. TrenePorter'e Phone 4.1 i <br /> n iR/11R(V RGIYINns <br /> N <br /> 7. Transporter 2 Company Name S. US EPA ID Number E. Slate porter'oPhon ID <br /> F. Trensporter'e Phone <br /> m <br /> 9. Designated Facility Name and Site Adtlresa 10. US EPA ID Number G. State Facility's I <br /> ROMIG CHEMICAL CORPORATION G A (J o 0191415121815171 <br /> V���Q WI r3�.�1.. eras �a ����y II H. Facility's Phone <br /> Poad <br /> )A0 I� Paco Aft CA "IM f� M � 5117 415 324" &% <br /> 'IZ 12. Containers 13. Total 14. I. <br /> �•g• 11. US DOT Description(Including Proper Shipping Name,Hazard Class,end ID Number) Quantity Unit Waste Nc. <br /> No. Type Wt/Vol <br /> nit <br /> YUsState <br /> Z MASTS ACETONE SOLVENT (FLAMMABLE LIQUID) 1 TT GAI 214 <br /> O� a 1893 / EPA/O her <br /> 6i R b /n� `IZ �� � N O Set I <br /> TA v Vy— fi�G EPA/Other <br /> T <br /> NR State <br /> C. 1 ) <br /> 8 EPA/Other <br /> m <br /> w d. state <br /> ZZi EPA/Other \� <br /> U <br /> N J. Additional Descriptions for Materials Listed Above K. Handling Codas for Wastes Llated Above <br /> o MXXT= OF ACETON7iv, CALCIUta SULFATE (FILLER) a. b. <br /> 0- : CELLULOSE (FILLER) CALCIUM CARBONATE (FILLER) p tl <br /> ¢ Mm (HAMMER) <br /> Z <br /> Z <br /> 0 15. Special Handling Instructions and Additional Information <br /> i (CAUTION — FLAMMABLE) <br /> �a,,..�.� (y�ryry�pQ p},.M�.r� /h�,,{y,� REFER TO RTTACHED M.S.D.S::4,.t f/ r--'!✓ <br /> 4iVeaJf G0991 ter and F'tV6O tkire 43l]lfUa <br /> J <br /> J <br /> Q 18. <br /> U <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately y accords above pl proper shipping name <br /> � <br /> and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> 1 national government regulation.. <br /> m <br /> If I em a large quantity generator,I certify that I have a program in place to reduce�he volume and toxicity of waste ge�ratetl it the odegree I have nimize th <br /> O to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal curce555hStN available to me which minimizes the <br /> present and future threat to human health and the environment;OR.it 1 em a smal�fquantity generator.I have made a good lal)h of orf to minimize my waste <br /> U generation and select the best waste management method that la eveiieble to me"and)hat I can allord. <br /> Z Signature / Morim Oay Year. <br /> W Printed/Typed Name <br /> Lu <br /> 'gM T 17 Transporter 1 Acknowledgement of Recelpt of Materials <br /> Z R Signature ;� Month Dey Year <br /> < A Priloled/ITyPe(Id Name 7 \Y// <br /> u- <br /> 0 <br /> S UJ' !'!.• K7 :ti/IJ f.�t./f F'�('..n r�r^!1-. i�/ .Lr,... <br /> O P <br /> tu O 18, Transporter 2 Acknowledgement of He lot of Materials <br /> UR Printed/Typed Neme Signature Monlh—Day Year <br /> E <br /> Z_ <br /> 19. Discrepancy Indication Space <br /> 'I F <br /> A <br /> I <br /> o I <br /> L <br /> 1 20. Feellity Owner or Operator Certlflcation of receipt of hazardous materiels covered by II[It-meglast except as noted In Item 19. <br /> Y Printed/Typed Name JV <br /> CM1 �,{v Signature J , y, �� Month Day Year <br /> SI <br /> IGM <br /> SORM& Hill <br /> 122 A(1188) Do Not Write Below This t U f "" <br /> w-22 qq rNLLOW: GENERATOR RETAINS <br /> 18)Previous editions are obsolete. �,7 <br />