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ano rrom o1 rage / -- Sacramento,California <br /> Please print or type. Form designed/or use on elite("-itch typewriter). <br /> UNIFORM HAZARDOUS inerator'a US EPA ID No. Manifest 2. Page 1 Information in the shaded areas <br /> Document No. <br /> WASTE MANIFEST 3 ' 1 of 1 is not required by Federal law. <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> -I� • I7 N ,CTS CORP. 9 0'1212 1 L o r <br /> I TL �fUL9 R r. 8. State Generator's ID <br /> PT <br /> � r ��f,oCA�LIF1 95205 ZQ9 �k�E-$9i4 {24 F;r, hdtIN�E3ETt n <br /> ( ) ) t i 1 7 5 9 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID 13" <br /> U. G. CHEMICAL Pn P 0 P P 7 9 D. Transporter's Phone 925-f)391 <br /> N <br /> LO 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> 00 F. Transporter's Phone <br /> cc <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State PaciliWs ID <br /> ET I CAM W—LJ— <br /> L) 2095 NEWLANDS DRIVE EP,ST H. Facility's Phone <br /> �.. Z FI_RINLEY NEVADA 89204 v r 35 13 8 -9931) <br /> O12. Containers 13. Total 14. I. <br /> <L 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> Ni. Type Wt/vol <br /> J <br /> a, state 431 <br /> .%I Z G NON—RCCA HAZARDOUS WASTE SOLID EPA/Other <br /> :S3 E Zl.;X PHOSPHATE FILTER CARE <br /> N <br /> E b. State <br /> Tif N R <br /> � <br /> T _ EPA/Other <br /> v O .n <br /> R C. �• ' ` J State <br /> o P 1 <br /> iP EPA/Other <br /> 4 W d. State <br /> r <br /> Z <br /> W EPA/Other <br /> LU <br /> Z J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> a. b. <br /> MOSIVE R ATERIAL COMPO BENTS <br /> ZINC AND IRM PHOSPNIATE 60 - s n C. d. <br /> lJ <br /> Z <br /> O <br /> H 15. Special Handling Instructions and Additional Information <br /> Z WEAR PROPER PROTECTIVE EQUIPMENT WHEN HANDLING (GSHA LEVEL "C" ) <br /> w <br /> ETICAN PROFILE # M91-078-'01 - AFPOI> R-r-ENT # TC1871 - PER CHRIS <br /> J <br /> J <br /> 0 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,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> n. national government regulations. <br /> Cn <br /> ccIf I em 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 i <br /> 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 /> cc <br /> present and future threat to human health and the environment;OR, if I am a sme 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 m and that I can afford. <br /> 0 I <br /> LUPrinted/Typed Name Signflt Month Day Year i <br /> W T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> Z A Printed/Typed NameSignature Month Day Year <br /> ¢ N 1 <br /> LL <br /> 0 S <br /> w O 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> ¢ <br /> R Printed/Typed Name Signature Month Day Year <br /> 0 T <br /> E I <br /> Z <br /> 19. Discrepancy Indication Space <br /> F I <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. <br /> T <br /> y Printed/Typed Name Signature Month pay Year <br /> _- i <br /> DHS 8022 A Do Not Write Below This Line <br /> EPA 8700-22 <br /> (Rev.6-89)Previous editions are obsolete. <br /> Yeliow: TSD- SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />