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r ,. . .- <br /> lir <br /> State of 21Wrnio—Enviropmental Protection Agency a + <br /> Form Appro � <br /> No.2050-0039(Expires 9-30-94) Iht�rultions on back of F 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch)typew—dr. Sacramento,California <br /> UNIFORM HAZARDOUS 1. M rotor EPAOD'No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST C A <br /> tplolq171121161811 12161 Z111 I r. <br /> +�3. Generator's Name and Mailing Address A. State Manifest Document,Number. 93182813 31 Q V 2 �./ <br /> in Sumiden Wire Prodmcts Corporation <br /> ^ 1412 El Pinal Drive, Stockton, CA 95205 B. State Generator's ID <br /> 4. Generator's Phone (209) 466-8924 <br /> Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID <br /> 00 fJ 3TA E t�10-iv2 T120!S fT 4 0 fl Jr �' g q 7 D. Transporter's Phone <br /> J <br /> J 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> 7U <br /> F. Transporter's Phone <br /> VQ 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> D Chemical Waste Managementi� ,l- I <br /> 7 LL 35251 Old Skyline Road H. Facility's Phone <br />-�� Kettleman City, CA IC I AlTj 01010161411 1 11 11 7 (209) 386-9711 <br /> 7 11. US DO. scri tion(includingProper Shipping Name, Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br />�z P P PP g No. Type Quantity Wt/Vol 11. Waste Number <br /> t- <br /> 3: - a. State <br /> 3 �+ pis EPA/Other <br /> G " `� .., w 0 0 1 C M 0 0 4 Y <br /> c:; E Non=RCRA Hazardous W ste 5ci�iswpc <br /> 00 N b. State <br /> 0o E <br /> N R K �'Elp 2 61905. EPA/Other <br /> A <br /> 00 T C. State <br /> 00 <br /> R STi -i77:74-,'C A <br /> EPA/Other <br /> LU <br /> Z — <br /> d. , State <br /> Z <br /> U r' <br /> V) I EPA/Other <br /> LLJ <br /> Q1. Addiitio riptions for Materials Listed Above', "K. Handling Codes for Wastes Listed Above <br /> Swecp�ngs - Maitit. Clean-G Materaz� -� a, D b. <br /> U, ed Drawiag VAmpounds <br /> C. d. <br /> 0 15. Special Handling Instructions and Additional Information <br /> a (Haz. Bulk, DOHS "C"' Regd) In Event of Emergency - Contact <br /> Z W p�ofil �pp��= 71 C.W.M.I. at (206)652-9221 <br /> 4 <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 res m proper condition for transport b highway according to applicable federal,state and international laws. <br /> Q P PeCh� P P Po Y 9 aY 9 PP <br /> U i <br /> If I am 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 /> economically practicable and that I have selected the practicable method of tr4tment,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 gen -tor, 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 1 can afford. i <br /> 0 Print d/Typed Name Signa Month Day Year <br /> , <br /> Y t Q v <br /> yT 17. Trans orter 1 Acknowled ement of Receipt of Materials <br /> LU A Pn d/Typed Name Signature Month Day Year <br /> s .Z2r c <br /> LLJ P <br /> 0 18. Trans ort 2 Ac nowled ement of Receipt of Materials <br /> su T Printed/Typ Name Signature Month Day Year <br /> U- <br /> E <br /> 0 R <br /> W 19. Discrepancy Indication Space / lL <br /> A _ <br /> r20. ili Owner or O orator Certification of recei t of hazardous materials covered b this manifest exce t as noted in Item 19.T d/Typed Name Sign re, Month Day Year <br /> sem- 0( - <br /> DO No WRIT K(6W THIS LIN '�-' <br /> Yellow: TSDF E THl5 COPY TO GENERATOR WITHIN 30 DAYS. j <br /> DISC 8022A (7/92) (Generators who submit hazordow. waste for transport out-of-hate <br /> EPA 8700-22 produce completed copy of thn copy and send to DTSC within 30 day <br /> r � <br />