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IHIe Of <br /> *proved OMS No.2050--0039(Expires 9.30-91)• and Front of Page ) Sacramento,U811forma <br /> Please-�rint or type. Form designed for use or.elite tic typewriter). <br /> "M <br /> lenerator's US EPA ID No. + anifest 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS Document No. of is not required by Federal law. <br /> WASTE MANIFEST c <br /> A. State Manifest Document Number <br /> 3. Generator's Name and Mailing Address N9 2 1014 <br /> SU1~IIDEN WIRE PRODUCTS CORP,,. B. State Generator's ID <br /> 1412 EL FINAL DRIVE STOCKTO�i, CALIF. 95205 <br /> 4, Generator's Phone( !1(209) 466-8924 24 }SOUR NUMBER �1 A Hi 013161 -101 117151918 <br /> O <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID <br /> .3017 <br /> D. Transporter's Phon <br /> u) <br /> UNIVERSAL EUINEERING <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State TranIDsporter's <br /> ap F. Tranaporter's Phone <br /> 0 <br /> 0 <br /> C9 9. Designated Facility Name and Site Address 10. US EPA ID Number (3. State Facility's IQ � <br /> CHEMICAL WASTE MANAGEMENT O � 6 <br /> H. actlity'a Phone <br /> '2 '1 OLD SKYLINE ROAD <br /> ' a KETTLEMNi HILLS CA. 93229 0r <br /> ZO 12. Containers 13. Total 1ni I- <br /> Quantity Unit Waste No. <br /> 0 1Y. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) No. Type Wt/vol <br /> State <br /> ' 0 a. ' EPA! <br /> GNON-RCRA HAZARDOUS WASTE SOLID <br /> E <br /> � F O O l c ht 0 0 0 Y <br /> _ N _ State <br /> E b. <br /> t,'t f EPA/Other <br /> m T <br /> 0 State <br /> R C. e / EPA/Other <br /> o <br /> i <br /> � E r <br /> I State <br /> d. <br /> Al: {t <br /> —� r''• EPA/0ther <br /> Z <br /> LU <br /> L) <br /> K. Listed Above <br /> Handling Codes for Wastes <br /> ZJ. Additional Descriptions for Materials Listed Above a b. <br /> SWEEPINGS C3 AINT. CLEANUP MATERIALS -._-USEFi_.D AWII G —3__ __ <br /> __ -- - <br /> CL <br /> W COI+fpoutiDS d. <br /> ccJ <br /> Q <br /> 15. Special Handling Instructions and Additional Information <br /> a I14 EVPIT OF EMERGENCY CONTACT <br /> Z (HAZ BULK, DOHS BOX t:C„ REQD) Ck;MI AT (205) 652-9721 <br /> F CWMI PROFILE # AJ1871 <br /> J <br /> J <br /> Q 16. <br /> Oro proper shipping name <br /> J GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by p p PP g <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 /> a 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 toxicity of waste generated to the degree I have determine <br /> and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> to be economically practicable <br /> O present end future threat to human health end the environment;OR,if I a 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;voila tom and that I can afford. <br /> O G Month Day Year <br /> ` l <br /> Priign re <br /> �ted/Typed Name f J ` <br /> Cr <br /> Lu <br /> LM T 17. Transporter 1 Acknowledgement of ecelpt of Materials <br /> LM R Month Day Year <br /> Z q Printed/Typed Name <br /> N Signature f <br /> a I <br /> LL S .4. {,j �l <br /> O P <br /> Lu <br /> O 18. Transporter Acknowibdgement o Receipt of Materials Month Day Year <br /> Cl) RPrinted/Typed Name Signet <br /> 0 T <br /> O E i <br /> Z_ <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. Month Day Year <br /> T Signatu _ <br /> y Printed/Typed Name <br /> DHS 8022 A Do Not WritE ow This Line <br /> EPA 8700-22 .- <br /> (Rev.6-89)Previous editions are obsolete. ' �. _ ' ; :�/' j Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAY: <br />