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ai e'off0 ni0—Environ }*(tion Agencya..—.– <br /> �orm pprove OMB No.2 9(Expires 9.J094) See Instructions on back 7 e 6. <br /> • Please print or type. Fo 9 Department of Toxic Substances Control <br /> for use on elite(I2-piKA� „-*writer. <br /> Sacramento,California <br /> UNM HAZARDdUS 1. GZwerofois US EPA ID No. Ma`Alfesl 0ocument No. 2. Page 1 Information in the shaded areas <br /> ASTE MANIFEST is not required by Federal law. <br /> " _ • � 17 ,-0,, <br /> � 1 of <br /> 3• or's Name and Mailing Address r ': J I0te Manifest Document Number <br /> 0 den 'Wirn products Cornor tion <br /> 1`1so <br /> 12 E1 viral Drive <br /> I N taOck�gr CA 95205 r l te Generator's ID <br /> ner or s Phone I n it `� <br /> - 4 I <br /> 6 5. Transporter 1 Company Name ! 6. US EPA ID Number ate Tronsporfer's ID <br /> TRI STATE MOTOR TRANSIT �, (' D ,, 9 5 0 3 3 9nsporters Phone 1 . tg00} 742-16fi1 <br /> —+ 7. Transporter 2 Company Name 8. US EPA ID Number te Transporter's ID <br /> U <br /> N mporfer's,Phone <br /> NoQ 9. Designated Facility Name and Site Address 10. US EPA ID Number te Facility' ID <br /> Chemical 4�'aste Manan ens61 ;35251 Old Sk line Road00� y ili}y-,Phone <br /> � Kettleman City; CA CAT 0 0 F 4 1r. . 11 <br /> M1I- US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> T <br /> V/z No. I Type Quantity Wt/Vol .1, Waste Number <br /> �_ a• State <br /> 1D1 <br /> 3 "Lon-RCRA Hazardous Waste Solid 0 0 1 C PA O O O 1 R `� EPA/Other <br /> chi E <br /> 00 Nb State <br /> E <br /> c,4 R -TPA/&h;, <br /> o A <br /> o T — -- <br /> O star®' <br /> R EPA/Jther <br /> W <br /> ►— -- —— — <br /> Z d' State . <br /> W <br /> U -- <br /> W EPA/Other <br /> v7 � <br /> Z :% rsptroess { 'Handling Co es for'Wasies listed Above <br /> ° Swf•epi gs �fixift. �a�. b -I <br /> a <br /> l)SCd Di^awiln 1 Coltipotlntls s �i <br /> d. <br /> a f - <br /> Z -- ---�—-- --- -- <br /> 0 15. Special Handling Instructions and Additional Information <br /> Z (Haz. Bulk, DOHS :'C" Regd) In Event of Emergency - Contact <br /> W C.W.M.1 . Profile # AJ-1871 C.W."!. T . at (206) 652. 9221 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents t the consignment are fully and accurately described above by proper shipping name and are classified, <br /> J packed,marked,and labeled,and are in all respects in proper condition for transport b highway according to applicable federal,state and international laws. <br /> Q P Pe P P P Y 9 Y 9 PP� <br /> U <br /> If I am a large quantity generator, I certify that I have a program in place o reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> J economical practicable and that I have selected the racticable method of <br /> atment,storage,or disposal currently available to me which minimizes the <br /> IY P p g p y present and future <br /> CL <br /> N threat to human health and the environment;OR, if I am a small quantity g erator, I have made a good faith effort to minimize my waste generation and select the best <br /> W waste management method that is available to me and that I can afford. <br /> 0 Printed/Typed Name Sign Month Day Year <br /> nl F E <br /> Z T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> W <br /> L A Printed/Typed Name Signator Month Day Year <br /> w P <br /> 0 18. Transporter 2 Acknowledgement7of Receipt of Materials <br /> W tit <br /> T Printed/Typed Name SignatureMonth Day Year <br /> LL E <br /> Q R1 <br /> N19. Discrepancy Indication Space <br /> UA <br /> Z 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 Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSGF SENDS fH15 -CPY TO GENERATCP. WI Hlrl ; a <br /> DTSC 8022A (7/92) G#merntor< who .uhmrt hrs;ardc., Hm;nr 'or <br /> EPA 8700-22 prod.(? ;:omplete-: -v 0 :his ipv vn,t ..!mi ..,. <br />