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i State of;alifornia—Environmental Protection Agency Form App!oved OMB No.2050-0039(Expires 9-30-94) See Instructions on back ge 6. Department ra Toxic Substances Control PleasO print or type. Form designed for use on elite(12-pita writer. Sacramento,California 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas UNIFORM HAZARDOUS is not required by Federal law. WASTE MANIFEST CIA ID lo Ir, q Ii 2 Is Is 17 1 1 1 r, I 1 9 1 A of 3. Generator's Name and Mailing Address A. State Manifest Document Number RO Lab Rubber Conpmy 95197287 8830 West Liruze Road, Tracy, CA 95376 B. State Generator`s 1D ' N 4. Generator's Phone W 0 5. Transporter 1 Company Name 6. US EPA ID Number C. Stoto Trontporte? D , v "' O D Tm6l�ptiSrsRtigget 4� d b r�4° f .: DE;CON Environmental Services,Inc.1 CI Al DI 91 81 21 A �. 7. Transporter 2 Company Name 8. US EPA ID Number ) State 7tar�sprster`z�[p t a wr ' V F Transwrierk ` `" t. Crosby and Overton CI A DI 01 21 81 4109101 11 E /Y\Z 9. Designated Facility Name and Site Address 10. US EPA ID Number G State'Pptt)tt�tp No Crosby and Overton � x �-� 1630 Gest 17th Street, Long Beach, CA 90813 ��t�`s zy; r , Q"QI CI Al 0101 S)I AI 416 16 11 .�. V-4U12. Containers 13. Total 14. Unit 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number-cam.» Za. State ' V♦� vlaste flammable Liquid, n.o.s., 3 UN19931 r' 1 EPA/Other G PG II DI M G c� E State 0 N b. RQ Hazardous Waste Liquid, n.o.s., 6.1, ; v E UN 1897 PG III EPA/Other CN A tetrachloroeth l 0 10 1 DI M 0 1 1 K< G -, - o T r1or-•RCRA Hazardous Baste SolidOP 0 0 4 state EPA/Other R (Detergent ph-7-8) 03 D IM P 1U State Z d. Non-RCRA Hazardous Waste Liquid U EPA/Other - w (Water with resin) q qj D MS G Imo. 1 on t oys r Ahatenals Usttd Above K. Handling&,&s for Wastes Listed Above w 11b) 1.733 13 �4l12x13 Ott; i3 d. c.- O 15. Special Handling Instructions and Additional Information a AVOID CONTACT. WEAR APPROPRIATE PROTECTIVE EQUIPMENT W101IIANDLING. Z = GENERATOR 24 HwR EMERGENCY PHONE 11U4WR (510) 975-2901. 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. Q UU If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage,or disposal currently available to me which minimizes the present and future d threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. OPrincej�,I,/Typed Name Signature F Monthp Day Year 0 S 1 even t�a�� _+ Za 17. Transporter 1 Acknowledgement of Receipt of Materials w A Printed/Tv-1-Name Signatgrc MoM Day Year <LLJF &— , 0 18. Transporter 2 Acknowledgement of Receipt of Materials w R Si nature Month Day Year T Printed/Typed Name 9 Signa— LL E 0 R LU 19. Discrepancy Indication Space V) Q F U A C Z 1 I 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. T Printed/Typed Name Signature Month Day Year Y DO NOT WRITE BELOW THIS LINE. DTSC'8022A (9/93) Yellow: GENERATCR RETAINS. EPA 8700-22 i