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S :f io—Envi onmental Protection Agency <br /> Form Approve OMB No.2054-0039(Expires 9-30.94) S44 Instructions on back of E 6. Deportment of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch)typewriter. Sacramento,California <br /> UNIFORM HAZARDbUS a 1. nerator's US EPA ID No. Mar11fe3? omen}No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST11 1 of <br /> 3. Generator's Name and Mailing Address �' + trite Manifest Document Number�] �'!� <br /> Sumiden Eire Products Corpor tion _ ., --�--� a G <br /> 827 <br /> to <br /> W) 1412 E1 Pinal Drive - <br /> n tate Generator's ID <br /> N tP So,nP. CA 95205 a 1 3 0 ° `- <br /> ner ors hone 1995 1 1171 S1 C <br /> 1 R1 <br /> O 5. Transporter 1 Company Name f 6. US EPA ID Number 'tate Transporter's ID <br /> �6 5� <br /> oTRI STATE MOTOR TRANSIT {any orter's Phone <br /> M 0•D 0 9 5 0 3 8 9 9 8 P (800) 742-1671 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number tote Transporter's IQ 1 <br /> Q <br />�U <br /> J 'R Transporter's Phone <br /> JQ 9. Designated Facility Name and Site Address 10. US EPA ID Number G. tote Facilty's ID <br /> W Chemical Waste Management � I �� f) � <br />�0 35251 Old Skyline Road H. Facility's Phone <br /> LL <br /> U Kettleman City, CA ICIAITIOIO10161416111117 ;( Q9� 386-9711 <br /> 7 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br />'Z No. T Quantity Wt/Vol I. Waste Number <br /> a• State <br /> 1v1 <br /> 3 Non-RCRA Hazardous Waste Solid 0 0 1 0 0 0 0 1118 y EPA/Other <br /> 04 E <br /> ado N b. State <br /> 00 E <br /> V R EPA/Other <br /> o A <br /> 00 T C. State <br /> O <br /> ce R EPA/Other <br /> W <br /> d <br /> Z State <br /> U <br /> W EPA/Other <br /> N <br /> Z 1`Additional Descriptions for Materials listed Abo ; r andling' es for a"es listed Above <br /> Sweep#ng - h'ain Clen Up.�iter�ials - s a n b. <br /> LU (JSe+ Dr li nc� Corn,ounds, �` U <br /> Z <br /> 0 15. Special Handling Instructions and Additional Information <br /> a (Haz. Bulk, DOHS "C" Reqd) In Event of Emergency -- Contact <br /> Z <br /> W C.W.M.1. Profil+e # AJ-1871 C.W.M.I. at (206) 652.9221 <br /> ' <br /> s <br /> I-- <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that 12 contenh of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <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 /> economically practicable and that 1 have selected the practicable method of t atment,storage,or disposal currently available to me which minimizes the present and future <br /> Nthreat 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 /> 0 Printed/Typed Name Sig Month Day Year <br /> >- ti U N o(� b I ( 12 1 D E <br /> Z T 17. Trans orter 1 Acknowledgement of Receipt of Materials <br /> W R <br /> 0 N Printed/Typed Name Signatur Month Day Year <br /> of s G D s <br /> W P <br /> 0 18. Trans orter 2 Acknowledgement of Receipt of Materials <br /> W T Printed/Typed Name Signature Month Day Year <br /> LL E <br /> OR <br /> LU19. Discrepancy Indication Space <br /> V F <br /> V A <br /> Z C <br /> I <br /> L <br /> 120, Fo ility 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 1 G <br /> 1 DO NOT WRITE BEL THIS LINE. <br /> IF <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> DTSC 8022A (7/92) (Generators who submit hazardous waste for trormport uu+or stutr <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC wrthm "q') :i: <br />