Laserfiche WebLink
Form Approveo omb No.euou—Uwd lcxpires a-3u-a / <br /> Please print or type. Form designed for use on elit '-pitch typewri(er). and Front Of Page 7 y Sacramento,California <br /> NIFORM HAZARDOUS - Gener tor's > PA ID No. Manifest 2. Page 1 Information in the shaded areas <br /> Document Noy <br /> WASTE MANIFEST f G 9 7 O E o 1 2 C U •0 f. 1 or 1 snot required by Federal law. <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> SUMIDEN WIRE PRODUCTS CORP. 90 9 <br /> 1412 EL PIt#AL DRIVE STOCKTON. CALIF. 05206 B. State Generator's ID <br /> 4. Generator's Phone( ) n - <br /> 0 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID I <br /> LO <br /> LO <br /> GIT 1p n 10 10 1113 14 16 19 D. Transporter'.spoer'.Phone <br /> N <br /> 1;Igg <br /> LO 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> 0o F. Transporter's Phone <br /> C? 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility s ID <br /> CHEMICAL WASTE "4ACEMENT <br /> 35251 OLD SKYLINE ROAD H. Facility's Phone <br /> 0 Z KETTLEMAN HILLS, CA. 93223 C A 7 0 O O f 6 11117 (209) 386--9711 <br /> ..�- O 12. Containers 13. Total 14. 1. <br /> W 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> No. Type Wt/Vol <br /> < a. State <br /> ^r, E 1 Vti--RCRA r#A7ARD:�I;S 'WASTE SOLID .. _ D i0 1 C m 0_A0101/ 0 Y EPA er <br /> N <br /> ems.+ 3 E b. State <br /> cv R <br /> mT EPA/Other <br /> c O <br /> cli <br /> R C. State <br /> CP v EPA/Other <br /> W <br /> d. State <br /> Z <br /> U <br /> EPA/Other <br /> wWi J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> a: b. <br /> a <br /> Uj SWEEPINGS — �MINT. CLEANUP MATERIALS - USED DRAWINGC. d <br /> JCOMPOUSIRDS <br /> < 1 <br /> Z <br /> 0 <br /> � 15. Special Handling Instructions and Additional Information I <br /> Z (HAZ. SULK, OOHS BOX °C" REQD) IN EVENT OF EMERGENCY CONTACT <br /> C+ '��I PROFILE AJ1871 DIMI 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 /> 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 /> ¢, national government regulations. <br /> If I am a large quantity generator,I certify that I have a program in place to red the volume and toxicity of waste generated to the degree I have determined <br /> to be economically practicable and that 1 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 e a sm 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 /> � i <br /> W Printe /Typed Name Sign Month Day Year i <br /> W 1 �Jc r1 ._ o G v 1912 t <br /> WT 17. Tran porter 1 Acknowledgement of Receipt of Materials <br /> R <br /> ZA Printed/Typed Name r Signature Month Day CyYear <br /> LL S <br /> W <br /> PO 18. Transporter 2 Acknowledgement of Receipt of Materials i <br /> < R Printed/Typed< T Name Signature Month Day Yepr <br /> U E <br /> Z <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility ner or erator Certifi n of receipt of zardous materials coveredlfy this maftifest except as noted in Item 19. <br /> T <br /> y Printed yped Nal/ Signatw6 Month Dnv Yepr <br /> _.ter-� / � �,�� <br /> DHS 8022 A Do Not Write Below This Line <br /> EPA 8700-22 <br /> (Rev.6-89)Previous editions are obsolete. <br /> icJ,3- : TSD. SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />