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State of Colifornio—Environmental Protection Agency r.� <br /> For Ad 039(Expires 9-30-94 sructions on back of 6. Department Topp Substances Control <br /> PP. ( P ) F De artment o <br /> Plea type, Form designed for use on elite(12-pitch)ypewfirer. %F Sacramento,California <br /> 1. Generator's US EPA ID No. ow I Ma i s Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS . ..�.. is not required by Federal law. <br /> WASTE MANIFEST CAD 0 9 7 0 6 8 1 2 6 . U I L ' 1 1 3 1 of 1 <br /> 3. Generator's Name and Mailing Address 5tate'Manifest Document Number O A C <br /> SUMBEN WIRE PRODUCTS CORPORATION <br /> 1412 EL PINAL DRIVE, STOCKTON, CA. 95205 ,8, State Generator's ID <br /> in 4. Generator's Phone ( ) 209 466-8924 �N A10 3` 6 - 41 1 7151.9.1.8 <br /> 5. Transporter 1 Company Name b. US EPA ID Number C. StaFa Transporter's ID <br /> TRI STATE !,10TOR TRANSIT INOD 10 1915101318191 9118 D. Transp°rte`s P"°ne 800 386-1671 <br /> J <br /> J 7. Transporter 2 Company Name 8. US EPA ID Number "E;"State Transporter's ID <br /> 7 V <br /> JF. Transporter's Phone <br /> jQ 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Stale Facility's ID <br /> W CHEMICAL WASTE MANAGEMENT -14 (11 11 117 <br /> J 35251 OLD SKYLINE ROAD H. Facility's Phone <br />+QKETTIF <br /> V 12. Container, 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) <br /> Type Quantity Wt/Vol 1. Waste Number <br />' a. r y State <br /> G NON-RCRA HAZARDOUS WASTE SOLID r 010 1 ` �� Y EPA/Other <br /> Ci E <br /> doN b. State <br /> E � 5 <br /> N R V 'EFA/Other <br /> A <br /> 0p TC. t' State <br /> a^y <br /> R Al EPA/Other <br /> W <br /> t— d. State <br /> Z <br /> W <br /> U o� <br /> EPA/Other <br /> W <br /> Z Y' clrtroral"Descriptions♦ar erials ltsove' A 1C: Flandfin'g`Coife's'for' aster fisted Above <br /> SWEEPINGS I�AI�JT. 'CLEAN-UP MATERIALS ,„ b. <br /> LU OSEI3 DRAW1��0 C030U }S . <br /> Q <br /> Z — --- <br /> 0 15. Special Handling Instructions and Additional Informalan <br /> P (HAZ. BULK, DOHS ''C" REOD) IN EVENT OF EMERGENCY--CONTACT <br /> Z C.W.M.I. PROFILE # AJ-1871 CWMI AT (205) 652-9221 <br /> LLJ <br /> Am t1 1ST yS <br /> J 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 /> J <br /> 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 g PP� <br /> V <br /> If I om 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 to be <br /> J economically practicable and that I have selected the practicable method of tre mens,storage,or disposal currently available to me which minimizes the present and future <br /> d threat to human health and the environment;OR, if I am a small quantity gen _tor, I have made a good faith effort to minimize my waste generation and select the best <br /> N <br /> waste management method that is available to me and that I can of <br /> 0 Printed/Typed Name Signatu Month Day Year <br /> >_ 1At N6 ! D Z 10 1S <br /> Z T 17. Trans orter 1 Acknowledgement of Receipt of Materials <br /> W R <br /> A Printed/Typed Name Signature Month Day Year <br /> LLJ <br /> P v <br /> 0 18. Trans orter 2 Acknowledgement of Receipt of Materials <br /> W T Printed/Typed Name - Signature Month Day Year <br /> U_ E <br /> 0 R <br /> N19. Discrepancy Indication Space <br /> Q F <br /> V A <br /> Z C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of reeei t of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> l <br /> DO NOT WRITE BEL THIS LINt. <br /> a <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (7/92) (Generators who submit hazardous waste for transport orrt-of-ctatr <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC wither :ti :. . <br />