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aV-UO3Y ea9-30-99 5ee Instructions on backof a e 6. <br /> _ plaou <br /> in, <br /> or ype. Form designed 16,we on alit(12- kh . P 9 Deportment of Toxic Substances Control <br /> ps l%PewritsSocromento,California <br /> UNIFORM HAZARDOUS a x0'a US EPA 10 No. Manifest Do ument F 2. Page 1 nformation In the shaded areas <br /> WASTE MANIFEST �� �.j Is ml required by Federal love. <br /> Sl 3 g at l <br /> J. Gederalor's Name and Moiling Address A. State Manifest 0ocdmom Number <br /> .5 <br /> =:5r Es rc ae$ =40-, - -- 7 4 5 4 3 <br /> c 40oawbAs{p -A� p4ek AP:uE <br /> Q1 p„ A)fMA q3 a� B. State Generator's ID <br /> A. Generator's Phon�' <br /> 1 N 5. iransporler 1 Company Name 6. US EPA ID Number <br /> ,90 sq C. State Transporter',ID ter. <br /> m <br /> A p M T15 D:,Transporters Phone - �G <br /> 7 <br /> 4 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter',ID _ <br /> QF. Transporter',Phone <br /> co 9. Designated Facility Nome and Site Address 10. US EPA ID Number G. State F.cility'.ID. ^ <br /> CHEMICAL WASTE MANAGEMENT, INC. <br /> t 35251 OLD SKYLINE ROAD, KEITLEMAN CITY, CA 93239 H. F.a lays Ph.. - <br /> IAAT <br /> 10 In 16 la Ir, IT 11 17 <br /> J LoU I1. US DOT Deuri tion md.di Pro Shi n Nome,Hazard Class,and ID Number) 12. Container 13. Tbml ]A. Unn <br /> U P h rg per Shipping <br /> E� �♦ `Il��,s� ave w No. T Quantity Wt/Vol 1 Waste Number <br /> 1 <br /> � a Ir0EJ �/tyl.,./"Rmabiivii is A; ` Oub Stah 11 <br /> �3 G /\`r..� 1 MOW &,, 'i ., EPA/OLhe <br /> o N b- stord <br /> R <br /> v A <br /> C. <br /> 1 <br /> R _ EPA/Other <br /> ( w d <br /> Z 1511 ate <br /> w <br /> • V EPA/Other <br /> w <br /> ZJ. Additional Descriptions I.,,Ma ed.li kissleU,Above :` r• -"' K Handling Code for Wastes Used Above <br /> o til a• pAL-�5 of 6po ' <br /> iyoL'D "" ryPrJlj :A.. . . l r, b <br /> Y w V�o� <br /> a. <br /> d. <br /> r 1 f %?„ , .,x$u'+' ts (m-i�+'rL -t t,,r<. <br /> 0 15. Spedol Handling Instruct ons and Additional Informor on -(t` / /- <br /> z HANDLERS BE 40 FIOUR OSHA/SARA' (`TXAJ TNED •V.+, r <br /> w AND USE NIOSH- APPROVED PPE... <br /> EMMISEWY COMICT: (916X371-5747 <br /> Q16. GENERATOR'S CERTIFICATION: I hereby declare that the centeuts of this consignment aro fully and accurately deuriliid.b.ve by propershippng iname and are 1.,,iRed,Packed, <br /> U marked,and labeled,and are in all respects in proper condition for transport by highway according to apptaable ibh <br /> inational and national government regulations. <br /> v _.. <br /> If I am a large uant ` c <br /> g q y generator, comfy that li.+.a p oq am in placeaorduwthe' ohmr:and bxiciy of waste gene.ted ro rhe.degree I have deNreiimid to be economkaIt <br /> practicable and that I Awe selected the ncable,meRtad a1 treatment sunag.,'w petal cur an available to me wh cfr-m i za the <br /> y dY present and fvNn rhtwl b human heals <br /> 0 a,td titre envaonmem;OR,tf am a.sma l quamiy getiemror,T fiver modra good-faith effort to minimize my waste generation and select the best caste management method that is <br /> O available to me and that I can OEM. t':: " _ C• la K - <br /> y <br /> Prinfite/Typtal Name Signature i ') Month Day Year, <br /> Z I L i 1,eR I c L ✓ �.i <br /> W T 17. Traissixorter 1 Acknowlingerri of Receipt of Materials <br /> w 0 Printed/Typed Name S' naNr 1 Montt Day Year <br /> / <br /> 0 Tram ear 0 18. 2 Acknawl easent of Ri cc t of MaMials �•%. <br /> TPrinted/Typed Name natoreei r Month. Day Year_., <br /> y E <br /> s U 19. Discrepancy Indication Space <br /> Z I <br /> L <br /> I20. Fix.ilitvOwner orOperemarGelification of racai r of hazardoes materialscovered by this manifest exc t os noted in Item 19..."• <br /> T Princed/Typed Name Signaki Mendt Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> 1 <br /> DTSC 8022A(4/971 Blue: GENERATOR SENDS THIS COPY TO DISC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Bax 400, Sacramento, CA 95812-0400 <br />