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Form OMB No 2050-0039 p}ts9.30-99( , r.-. 1.. £' <br /> Please Par- - e.Ty'"1 See Instructions on back of a e 6. <br /> e. ",desigpd usebh-lift --ew.ifer. - P 9 Deparhnent 4 Tozic Substances Control <br /> $aerdmenro,California - <br /> L eraN/sUS¢FA.1 No Manifest Document 2. Pae 1 Infcfmation in die shaded arena <br /> - � <br /> UNIFORM HAZARDOUS`=�' - �. ✓_as'r,T -�-g.. g <br /> p WASTE MANIFEST is not*uimd by Federal low. <br /> T a sy3a aFP <br /> e3y-sGetftrarori Name andMoilitp Address <br /> ZJE <br /> 0 4`/O�eOy.sJwsJ <br /> ELLS F14+2 k AQ�vE r ; t/ <br /> A <br /> 4. Ge a ob a P an A. 9�3 7 <br /> h5. Transporter 1 Company Name - •4VS EPA ID Number ' <br /> CR <br /> RAMCK <br /> p - s <br /> O <br /> m 7. Transporter 2 Company Name _. <br /> 8. UB PAI Number <br /> V I 9. Designated Facility Name and Site Address - 10. US EPA ID Number�Q IM MICAL WASTE MANAGEMENT, INC. <br /> f <br /> 35251 OLD SYYLINE ROAD, YETITFMAN CITY, CA 83239 <br /> ��� 12. Canroinen 73. Total 14. Unit <br /> Y/V Il. US�DOT Description(Including Proper Shipping Nome,Hasord Clan,and ID Number) No.,, T Quantity Wt/Vd. <br /> r.F s <br /> A Y <br /> E b. <br /> Fi N <br /> J <br /> to E , t <br /> vR :�E. ... .. <br /> v A ...r . . {'. <br /> o T ` <br /> M O <br /> .R <br /> d. <br /> W <br /> W i' <br /> N <br /> Z <br /> 0 <br /> 6 <br /> N <br /> W <br /> K <br /> Q <br /> Z <br /> Q 15. Special Handling Imtrucdans and AddliwgTlnfarmatitl <br /> HANDLERS BE 40 "FOUR OSWSARlt f, ! <br /> AND USE NIOSH-APPROVED <br /> H .T CONTACT: (916-4t,371-5747 <br /> 16. GENERATOR'S CERTIFICATION: Ih declare that the canMh of this consignment am fullyad occuratel describidabo7a <br /> °r°6y gg Yy by PnWrshippad <br /> ingnrmnon classified,packed. <br /> V marked,and labeled,and are in all respects in prayer 2odRitl Ir <br /> for ansporttSy highway according soapphmble iritarnoriwm <br /> onal and notional gernmeregulations. <br /> r <br /> If I am a large quanM1ty generator,I certify that Fhdve Qpragram in.p15gla ieaii5a-the voluess and ro i<ity of waste generated to the degrd hero determined N be econorn".11Y <br /> HpractMakicable cnd that 1 have selected rhe ppracticable metmethodn teetment;storage,or dts�osal c n Py avaikbk N me which minimizes the present and future threat to hamon health <br /> and the environment;OR,if I am wsmall quantity gene .Fb4ve media gaad°Asirt N minimize my wash gtlerom <br /> tfon ord. eft management medtod that is <br /> O a mailable tome and that I can afford. <br /> VPrin /T Name• SignaNn Month Day Year <br /> W 1�' Ain <br /> Vr T 17. Transporter 1 Acknowledgement of Rtlei of Materials . <br /> W Al Printed/Tyged Noms Si'naNr t / Monde Day Year <br /> W P <br /> ,' 18. Tran 2 Ackn lodgement of ' t of Materials <br /> O ' <br /> 1 Y <br /> Prinmd/Typed Noma _ Nn <br /> D <br /> W E r Mtltb. ry. - tlr <br /> V 19. Discrepamq Indication Space - <br /> Z F ; <br /> A .� VIE <br /> C <br /> L <br /> 1 20. Focilit,Owrw or RgEtor Wcf,.n0.F s co st escaut as noted in n19. <br /> T Printed Na atone R 1 ly7 <br /> Y ` Mundt Day Year <br /> � . 0 <br /> w Pr,• $%�(�' �✓1i t2 E'f DO NOTKq <br /> fLt2.K .. v' Unc SENDS THIS COPY In GENERATOR WITHIN 30 DAYS. <br /> DTSC 0022A(4/971 (Generators who submit hozardous.waste For transport out-of-state, <br /> EPA 8700-22 produce completed copy of thiscopy and send to DTSC within 30 days.) <br />