Laserfiche WebLink
Stale of alifornia—Health anifWeuare Agency - Department of Health Services <br /> r Fprm Dovr OMD No.2050WW39(Wpires 9-30-o Toxic Substances Control Division <br /> P(ea prin r type. (Form designed for use one Titch typewriter). Sacramento,California <br /> UNIFORM HAZARDOUS 773enerat or's US EPA ID No. Manifest 2. Pepe 1 Information in the shaded areas <br /> Document No. <br /> WASTE MANIFEST C 4 Q of is not required by Federal law. <br /> 3. Generators Name and Mailing Address A. Stele Manifest Document Number <br /> UNIVERSAL RUNDLE CORP. 087 89893941 <br /> P-0- BOX 6395, STOCKTON, CA 95206 R. State Generator's ID <br /> 4. Generator's Phone( 209) 98?-0600 <br /> '96`0�CeCHE3 =AL GORPOF1AATtON e. US EPA ID Number c. taleTrana Hera lD <br /> G A D 0 0 8 4 S 2161617 D. Tran.ponars Phone <br /> N <br /> � ]. Transporter 2 Company Name 8. US EPA ID Number E. Slate Transporter's 10 <br /> o1 1 1 1 1 1 1 1 1 1 1 1F. Transporter's Phone , <br /> m <br /> P. Designated Facility Name and Site Atltlreae 10. US EPA ID Number G. Stale Facility's ID <br /> AOW$v CHEMICAL CORPafiAT10N CAR010,914,6191615 7 <br /> U 2081 Bay Hoed H. Facility's Phone <br /> rail a East fto AIW, CA 3.3303 GAD 0 0 4 A $ 2 61617. (415) V4.163$ <br /> V ¢ 12. Containers 13. Total 14. -1. <br /> OW 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> No. I Type WIIVOI <br /> Ua. Slate ^^ , <br /> los G WASTE ACETONE SOLVENT (FLAMMABLE LIQUID) 0 K2 I/ T t L EPA/rn <br /> r E <br /> 3 N <br /> E ti. vel, <br /> '- / Stele <br /> $ R <br /> A �� EPA/Other <br /> e O <br /> N <br /> v R C. State <br /> 6 <br /> 0 <br /> m <br /> EPA/Other <br /> w d. State '4 <br /> Z <br /> z <br /> w <br /> O EPA/Other <br /> w <br /> Z J. Additional Descriptions for Materiels Listed Above a. Handling Cotler for Wester Listed Above <br /> 0 MIXTURE OF ACETONE, CALCIUM SULFATE (FILLER), CELLULOSE <br /> b. <br /> (FILLER). CALCIUM CARBONATE (FILLER), MEKP (HARDENER) C. <br /> 0( it. _ <br /> J <br /> Z <br /> Z <br /> O <br /> F- 15. Spacial Handling Instructions and Additional Information <br /> Q a1t- <br /> W Gloves, Oogg'os, and Prate tive GotMng ✓n3 (CAUTION - FLA►p{ABLE) <br /> F y REFER TO ATTACHED M.S.D.S. <br /> Q 16. <br /> U / !.t <br /> GENERATOR'S CERTIFICATION: I hereby declare that the conlenl, pR1fiikcofsign ent are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in all re.pecfs,IP'prop0r'coPdition for transport by highway accprdi g to applicable international and <br /> d national government regulations. J <br /> W <br /> It I am a large quantity generator,I certify that I have a program m place to r da a vdlume and toxicity of waste genera d to the degree I have determined <br /> p O to be economically practicable and that I have selected the pract cable mel eetment,storage,or disposal currently/ veil bill to "ch minimizes the <br /> 1 T present and future threat to human health and the environment;OR,If 1 e small uentity generator,I have made a goge halt of minimize my waste <br /> p generation and select the best waste management method that is avail a to me ntl that 1 can afford. <br /> Z <br /> W PrinledlTyped Name ig for y •{ I Month Day Year <br /> W HETYIE A. POTTS �,•, y . <br /> W T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> Z A Printed/Typed Name Sign urs <br /> N Month Day Year <br /> Op ,rt - y a <br /> W O 18. Transporter 2 Acknowledgement of Receipt or Materials <br /> to R <br /> U T Printed/Typed Name Signature Month Day Year <br /> E <br /> Z_ <br /> 19. Discrepancy Indication Space <br /> F <br /> A A7 <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered t1his man' cep/as not m 19. <br /> T y� �1@�,� <br /> Y P.,k�lt�lTV31IS:S11W + signs re Month Day Year <br /> E{i Y ELLL�N/!�Ay B[3RCWSKE <br /> DHS 8022 A(1188) Do Not N to Below This Line <br /> EPA 8700-22 <br /> (Rev.9-88)Previous editions are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> I <br /> r'.��.�/J ��.rr ��. ✓' .J rrr �.v rd a.cw .s m4's ate.ss u ��.. .�� .._. __. _— � _. _ <br />