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Form Approveo UMb No.21JoU—uuoa(CApnbs ave-:a„ anU ri uu. u. r <br /> Please print or type. Form designed for use on elitee -itch typewriter). pan g aacramemo,ueuio „a <br /> UNIFORM HAZA �CpU3 eneratdr's'US EPA ID No. Manifest 2. Page i Information in the shaded areas <br /> Document No. <br /> WASTE MANIFEST Ic iA p in iq 17n 16 11 12 ; n of is not required by Federal law. <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> SURI DEN WIRE PRODUCTS CORP B. State Generator's ID 0 a z l <br /> 1412 EL PINAL DRIVE STOCKTON, CALIF_ . _95205 A fl 10 3 - 0 7 5 �' <br /> 4. Generators Phone( ) 1,20Q)466-8924 <br /> 0 5. Trayfporter 1 Company Narng„ 6. U$.EPA ID Number C. State Transporter's IDLn <br /> C ;r� r G D. Transporter's Phone <br /> IS 11 12 1 1 <br /> Zti 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> ao <br /> O F. Transporter's Phone <br /> 0 <br /> C9 ID <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's <br /> CHEMICAL WASTE F�A;faGElET <br /> H. Facility's Phone <br /> 0 35251 OLD SKYLING ROAD � <br /> n W, 9711 <br /> z r, A 4 <br /> 12. Containers 13. Total 14. I. <br /> U11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) _ Quantity Unit Waste No. <br /> No. Type Wt/Vol <br /> .J State <br /> --i 0 81 <br /> 'mss Z G N(14-RCRA HAZARDOUS HASTE SOLID EPA/Other <br /> E 0 10 11 Ch. 0 10 10 1114 Y <br /> N State <br /> �3 E b. <br /> 0 A EPA/Other <br /> amp T <br /> v O State <br /> cv R a <br /> v <br /> 0 <br /> O EPA/Other <br /> m <br /> Cr State <br /> w d <br /> Z EPA/Other <br /> LU <br /> U "�r <br /> W K. Handling Codes for Wastes Listed Above <br /> J. Additional Descriptions for Materials Listed Above <br /> a. b. <br /> Z <br /> W SWEEPINGS - VIAINT. CLEANUP :MATERIALS - OSED DW ING C. d <br /> COMPOUNDS <br /> J € <br /> < <br /> Z <br /> 0 <br /> � 15. Special Handling Instructions and Additional Information <br /> Z (HA2. BULKD4i�rS BOY "C" REQD) IN EVENT OF EMERGENCY CONTACT <br /> W CWMI PROFILE t AJ1871 CUIMI AT (205) 652-9721 <br /> J <br /> J <br /> < 16. <br /> U <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> J and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> J <br /> n, national government regulations. <br /> If I am a large quantity generator,I certify that I have a program in place to reduce the volume and tonicity of waste generated to the degree 1 have determine <br /> to be economically practicable and that I have selected the practicable method of tre ment, storage,or disposal currently available to me which minimizes the <br /> U present and future threat to human health and the environment;OR,if I am a smell qu ntity generator,I have made a good faith effort to minimize my waste <br /> } generation and select the best waste management method that is available to me an that I can afford. <br /> U <br /> LU Pr'nt /Typed Name ,q1 Signature Month Day Year <br /> W <br /> Lu T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R Month Day Year <br /> Z A Printed/T ed Name _ Signature _ <br /> < N <br /> o p <br /> W O 18. Transporter 2,h+cknowledgement of Receipt of Materiels <br /> U) R Printed/Typed Name Signature Month Day Year <br /> < T f <br /> U E <br /> Z R <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> L <br /> I 20. Fs y Owner or Operator Csrtification of race' of hazardous materials covered ey this manife6t except as noted in Item 19. <br /> T <br /> y Pri d/Typed Sne Signet Mrnth Day Yaar-7l <br /> _. fir-' _ '5-� <br /> OfI DHS 8022 A Do Not Write Below This Line <br /> R( EPA 8700-22 <br /> (Rev.6.89)Previous editions are obsolete. <br /> Yeilow: ?SUr SENDS THIS COPY TO GENERATOR WITHIN 30 DAPS <br /> 1 <br />