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Department of Health Services <br /> ;,—Health and Welfare Agency Toxic Substances Control Division <br /> -• OMB No.2050-0039(Lxpires 9.30-91• Sacramento,California <br /> or type. (Form designed for use on elite 1 typewriter). <br /> 1. Generator's US EPA ID No. Manifest . Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS Docamant NO. of is not required by Federal law. <br /> WASTE MANIFESTQ q, Stele Manifest Oocumant Number <br /> 3. Generator's Nam.and Mailing Address G _ -, ,e 8 <br /> 11 <br /> UNIVERSAL RUNDLE CORP. 087 <br /> B. Slate Generator's 10 <br /> P.O. 30X 6595, STOCKTON, CA 9506 <br /> 4. Generator's Phone( 209) 98 2-0 6 0 <br /> US EPA ID Number <br /> C. lata Tranriponer's ID. GF.'-/ <br /> i0 5�h hI11)It:/4.myvr�wv.r Me CAD 0 0 W-4 5 P 8 S 7 D. Tranaporter's Phone ,I <br /> r- 9Y <br /> r <br /> 8. US EPA ID Number E. State Transporter <br /> 'a � <br /> m 7. Transporter 2 Company Name i <br /> F. Traneponer's Phone 1 <br /> 10. US EPA ID Number G. State Facility's ID <br /> On 9. Designated Facility Name entl Site Address o A o 0 0 a 1416 s a s 7 <br /> ROMIC CHEMICAL CORPORATION H. Facility's Phone <br /> W01 Bay Road <br /> East P{IO Alto CA 84303 C A D 0 0 9 4 8 Z 6 6 7 (4155) 3324./0310 <br /> I. Z 12. Containers 13. Total IC I. <br /> end ID Number) Quantity Unit Waste NO. <br /> 0 11. US DOT Description(Including Proper Shipping Name,Hazard Class, No. Type Wt/Vol <br /> J State <br /> j a G a WASTE ACETONE SOLVENT (FLArMARLE LIMAID) ` 1 AL EPA/0t <br /> haff <br /> n 4 <br /> r7 N f State <br /> R {-/o A O n*7 /.) EPA/01her <br /> A <br /> m T <br /> a O State <br /> Y <br /> R c. <br /> g EPA/Other <br /> m <br /> Stale <br /> w d. <br /> Z <br /> EPA/Other <br /> W <br /> U <br /> Handling Codes for Wastes Listed Above <br /> K <br /> 0 J. Additional Description$for Materials Listed Above K.a. e. <br /> Z MIXTURE OF ACETONE, CALCIUM SULFATE (FILLER.) , CELLULOSE <br /> Q.w (FILLER), CALCIUM CARBONATE (FILLER.), )!EKP (A'�RDENOR) -01r d. <br /> J <br /> Z <br /> O <br /> H15..Special Handling Instructions end Additional Information <br /> z 1// G �/�°�rAUTT"M -. FLAVIIAULo <br /> W Gloves, GoW06, and Protective C1041111 . )°F �� `j orEu TO A.TTACHFD S.S.D.S. <br /> J <br /> J <br /> 8. l <br /> U <br /> GENERATOR'S CERTIFICATION: I hereby declarean that the 11 respects <br /> of this open c nditltare fully aqd accurately y accords above pl proper shipping name <br /> and are classified,pecked,marked.and labeled,and are In all respects in proper condition for tren�a/t-bY highway according to applicable international and <br /> a national government regulations. ; O V / ) <br /> n <br /> lL If I am a large quantity generator,I chatty haat I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determminimizes <br /> t <br /> ed <br /> to be economically practicable and that I have selected the practicable It I me a s of treatment.storage,or disposal currently available to me which minimizes the <br /> f present and future threat to human health and the environment;OR,if I am a smell quantity generator,I have made a good tette el)brl to minimize my waste <br /> V generation and select the best waste management method that Is available to me and that I can afford. <br /> g Month Uay Year <br /> w Printed/Typed Name Si nature . <br /> W <br /> HEWiB A. POTTS , . <br /> g2jI <br /> [nEe <br /> Acknowledgement of Receipt of Materials ' <br /> Signature " ' Month Day Year <br /> < Printed/Typedme ,� Z ; <br /> Acknowledgement of Receipt of MaterialsUme <br /> Signature Mon1A Day Year <br /> Z_ <br /> 18. Discrepancy Indication Space <br /> L / 7 <br /> 1 20. Facility Owner or Operator Cenificatlon of receipt of hazardous materials covered by this manifest except ea noted in Ilam 1 <br /> T Signature Month Day Year <br /> Y P,J$ iT PI f,F5E00RY gLISONJBAY Ili <br /> DHS 8022 A(1/88) Do Not Write Below This Line <br /> EPA 8700-22 <br /> (Rev.9-88)Previous editions are obsolete. YELLOW: GENERATOR RETAINS <br />