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Form Approvea UMii No.2050-0039(Expires 9-30.91) toxic Substances Control Division <br /> typewriter).P D ). <br /> Please print or type. Form designed for use on elitr pitch t and Front of P?^8 7 Sacramento,California <br /> UNIFORM HAZARDOUS 3enerator's US EPA ID No. Manifest 2. Page 1 Information in the shaded areas <br /> 4' <br /> DOCURIent No. <br /> WASTE MANIFE rj J 1 1 of is not required by Federal law. <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> lMIDEN WIRE PRODUCTS CORP. 90921024 <br /> 412 EL FINAL DRIVE STOCP TGNt -CALIF. 95205 B. State Generator's ID <br /> 4. Generator's Phone(209) 456_8924 H1Alhi 01316111 7151913 <br /> 5. Transporter 1 Company Name fv-$ �'? r C. State Transporter's ID <br /> � trrl7.Lr <br /> LO D. Transporter's Phone <br /> N (79V 446 6699 <br /> � <br /> 7. Transporter 2 Company Name 6. US EPA ID Number E. State Transporter's <br /> o F. Transporter's Phone <br /> CP <br /> 9. Designated Facility Name and Site Address 10. —US EPA ID Number G. State Facility's to <br /> HEMICAL WASTE MANAGEMENT 10161 y � /1/ 171 <br /> 5251 OLD SKYLINE ROAD H. Facility's Phone <br /> `— ETTLEI%N HILLS CA. i Ci Ai TiO 1010161 416 1 11 11 7 209 385-9711 <br /> � 1z <br /> O12. Containers 13. Total <br /> 0 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> QNo. Type Wt/Vol <br /> U a. State <br /> .� Z <br /> EPA. <br /> N NON—RCRA HAZARDOUS 'WASTE SOLID G O 1 C M 0 0 0 1 4 Y <br /> E b. State <br /> N R <br /> o A <br /> m T EPA/Other <br /> v O <br /> N R <br /> C. State <br /> c <br /> o _ <br /> EPA/Other <br /> LLI d. State <br /> Ww 31:iCi f 1: CA <br /> F? l <br /> 0 PA/OtherLU <br /> U/) J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> Z <br /> O a. b. <br /> IL <br /> LLJ /S+6(�IpEt(E�P(I�NGS — MAINT. CLEANUP MATERIALS —„USED DRAWING L d <br /> J i,rVt'11'"OUINDS <br /> Q <br /> Z <br /> O <br /> � 15. Special Handling Instructions and Additional Information <br /> U.1 <br /> (HAZ. BULK, VOHS BOX "C" READ) IN EVENT OF EMERGENCY CONTACT <br /> CWMI PROFILE # AJ 1871 D-114I AT (205) 652-9721 <br /> J <br /> J <br /> U 16. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,pecked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> national government regulations. <br /> Un <br /> 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 <br /> O to be economically practicable and that I have selected the practicable method of 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 em a s all 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 te and that I can afford. <br /> L) <br /> Z <br /> Printed/Typed Name Sign to Month Day Year <br /> 0 <br /> WT 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> Z A Printed/Typed Name -Signature Month Day Year <br /> LL S .; 1 .. <br /> O P <br /> W O 18. Trar6sporter 2 Ackrr6wfAgement of Receipt of Materials - <br /> R Printed/Typed Name gnature Month Day Year <br /> U E <br /> Z_ <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 NamSignature/ Signature Month Day Year <br /> r <br /> I/L51 f12 <br /> DHS 8022 A Do Not CYf if'e"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 />