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QAir.. <br /> arm App—OMB No.` 9.30.94) See.lnstrudtions on back 39e6. Department of Toxic Substances Control <br /> Please Print or type, f for usean eFre(I2piech ".r. ^t r Sacramento,California <br /> U <br /> T:lG*nAA,crt.r',US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br /> HAZARDOUS is not required by Federal law.STE MANIFEST F1 31 112h,,17 III of <br />( 3• is Name and Mailing Address Sfafe 6` botomsnt`Num r <br />{ h S den ','iri r-roducts Corporation <br /> r{ ^ 1 E 111 r t l !7 r i V A State Gen.rator,I D <br /> N tDckton CA 95205 !�L <br /> 40 4, nerator's Phone ( ) !r n Ia .1 i^ f; .1 HI Al HI Q1 ,q 1 61 -1 01 111.51 <br /> r tp <br /> 131, <br /> 5. Transporter 1 Company Name 6. US EPA ID Number State Tramporter's ID <br /> 00 <br /> — .f TRI STATE MOTOR TRANSIT �, � Tram r',Phone <br /> n �1915101318 Q 9 3JE,' <br /> P°"e (8 0 0) 742-1671 <br /> J rt7. Transporter 2 Company Name 8. US EPA ID Number State Transporter's ID � <br /> (`V <br /> N F. Transporter's Phone —� <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> �Z <br /> C�ierrical '.paste 'lanarer^ent I I I I I I I I <br /> 00 No 357.51 ^1 <br /> _ 'Skyline Road I H. Facility's Phone V� <br /> V--4Q Kettle.an City, CA CAT 0 0 0 c ri o 1 1 (209) 386-9711 <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. unit <br /> T Z No. Type Quantity Wt/Vol 1. Waste Number <br /> v'H a• State -` <br /> 181 <br /> 3 G Non-RCRA Hazardous ?'taste Solid 0 n 1 C M C n n 1 QQ u EPA/Other <br /> 04 E <br /> oob N b• State - <br /> 0o E <br /> c4 R ! EPA/Other, <br /> d A -- <br /> T C. State <br /> 00 <br /> R EPA/Othei <br /> W I <br /> ~ d. State <br /> Z <br /> w <br /> EPA/Other <br /> U.1 <br /> (n <br /> Zave <br /> erg Ab <br /> t + r <br /> O a.LLI <br /> C. <br /> d. <br /> b. <br /> Z ---- ------- - --- -- <br /> O 15. Special Handling Instructions and Additional Information <br /> z (Paz. Lulk, DOHS "C' decd) In Event of Erner,encv ': <br /> - Contac <br /> w C.!N.M.I . Profile 4 AJ--1871 C.W.M. T . at (206) 652 9221 <br /> I— <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> packed,marked,and labeled,and are in all res in proper condition for transport b highway according to applicable federal,state and international laws. <br /> Q Pa P�� P Pe P Y 9 Y g 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 1 have determined to be <br /> economically practicable and that I have selected the practicable method of t afinent,storage,or disposal currently available to me which minimi-es the present and fuh-e <br /> Hthreat to human health and the environment;OR, if I am a small quantity ge erator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. <br /> O Printed/Typed Name r Sign Month Day Year <br /> Z T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> a Printed/Typed Name Signature r Month Day Year <br /> / fi/, / r ! G <br /> W 5 T .�/(.ry!C: 'Y s^ Cj <br /> P ` <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> w T Printed/Typed Name Signature Month Day Year <br /> W E <br /> O R <br /> W 19. Discrepancy Indication Space <br /> N <br /> UIF <br /> A <br /> Z 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 Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (7/92) <br /> EPA 8700-22 <br />