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Please print or type. Form designed for use on elite r'^-Ditch typewriter). <br /> X anu riunt Oi Ya9tb r Sacramento,California <br /> UNIFORM HAZARDOUS enerator's US EPA ID No. Manifest 2. Page 1 Information in the shaded areas <br /> "WASTE MANIFEST C1 Al Q1 01 91 7101 61 81 11 21 61 <br /> Document No. <br /> 0101 01 61 91 of I is not required by Federal law. <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> UMI D£N WIRE PRODUCTS bORP �t��� �-L 'k f- <br /> 432 EL PINAL DRIVE STOCKTONK CALIF, 95205 B. State Generator's ID <br /> 4. Generator's Phone(209)466-8924 j/ 14 <br /> 0 5. Transporter 1 Company Name 6C A 0 C. State Transporter's ID O <br /> I"tIVERSAL ENGINEERINGTransporter'sPhone <br /> CP <br /> 7. Transporter 2 Company Name 8, US EPA ID Number E. State Transporter's ID <br /> o 1 1 1 1 1 1 1 1 1 1 1 1 F. Transporter's Pho r <br /> 0 <br /> C? 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID _ <br /> HEMICAL WASTE HAIZAGEMENT rill '- r ic?Cl 61 Y I If I <br /> v5251 OLD SKYLINE ROAD H. Facility's Phone <br /> z <br /> r '11111, ^ IAJ;-0711 <br /> O 12. Containers 13. Total <br /> 14. I. <br /> 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> ^") J No. Type Wt /Vol <br /> a State <br /> n <br /> Z G NON-RCRA HAZARDOUS WASTE SOLID l 0 EPA/other <br /> 5" E - <br /> N <br /> �.° E b. State <br /> n� <br /> �V) 0 A 1l I r I EPA/Other <br /> v O <br /> N C.R c —_' <br /> � Stets <br /> CP - - EPA/Other <br /> 2 <br /> w d. State <br /> I- <br /> Z <br /> wJ <br /> CEPA/Other <br /> U) J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> 0 a. h. <br /> EL SWEEPINGS - MAIhT. CLEANUP MATERIALS - USED DRMING <br /> W CwPOUNDS d. <br /> J { <br /> Q it <br /> Z <br /> 0 <br /> 15. Special Handling Instructions and Additional Information <br /> W (HAZ. BULK, DOHS BOX "C' REOD) ISI EVENT OF E14ERGEINCY CONTACT <br /> Ca', l PROFILE # AJ1871 DIMI AT (205) 652-9721 <br /> J <br /> J <br /> U 16. 1 <br /> J 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 /> d national government regulations. <br /> If I em a large quantity generator,I certify that I have a program in place to redu the volume and toxicity of waste generated to the degree I have determined 1, <br /> to be economically practicable and that I have selected the practicable method f treatment,storage,or disposal currently available to me which minimizes the <br /> present and future threat to human health and the environment;OR, if I am e s II quantity 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 a and that I can afford. <br /> 0 <br /> Uj Printed/Typed Name Signe Month Day Year i <br /> LU 4 <br /> WT 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> Z A Printed/Typed Name Si7tu,e Month Day Year <br /> 0 P <br /> LU O 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> < R <br /> Q T Printed/Typed Name Signature Month Day Year i <br /> U E <br /> Z R <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T _._ _ <br /> Y Printed/Typed N e Snre //i� Month/ Day Ynar <br /> q� / C� / J r <br /> DHS 8022 A Do Not-/�Irrite Below This Line <br /> EPA 8700-22 <br /> (Rev.6-89)Previous editions are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />