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State of CalifD rniu—Environmental Protection Agency <br /> Form Approved OMB No.20 0-00,39(Expires 9-30.94) Ste:}tons on back of -(fie 6. Department of Toxic S.M7=77 onces ont-i <br /> Please print or type. m si ned for use on elite(12-pitch) -iter. Sacramento, California <br /> Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST of <br /> 3. Generator's Name and Mailing Address I Stiff P 1 A. State Manifest Document Number <br /> LO o SUMIDEN WIRE PRODUC`rS T yr t` i <br /> 1412 EL PINAL DRIVE, STOCK , 95201 <br /> B. State Generator's ID 92180309 <br /> CV <br /> LO4, Generator's Phone ( �..� <br /> d 5. Transporter 1 Company Name �6. US tPA ID Number 'C. State Trartsperte s ID a' <br /> CHEMICAL WASTE MANAGEMENT L L$ � 0 2 61 Tromporters Phone <br /> J <br /> 7. Transporter 2 Company Name 8.J5„EPA.I6Nvinhrr—y E. State Transporters ID <br /> U <br /> F: Transporter's Phone <br /> QQ 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> 0 CHEMICAL WASTE MANAGEMEW <br /> M- 35251 OLD SKYLINE ROWD H. Facility's Phone <br /> C7Q <br /> K LEDIAN CITWo CA IC 1A IT 10 10 10 16 14 16 11 11 17 <br />��yy��� 12. Containers 13. Total 14. nit <br /> WZ 11. US DOT Description(including Proper Shipping Name, Hazard Class,and ID Number) No. Type Quantity Wt/Vol 1. Waste Number <br /> = a State <br /> N~ <br />�3 G MX4—RCRA HAZARDOUS WASTE SOLID 0 0 1 0 0 0 0 1 4 EPA/Ot r <br /> N E <br /> 0 <br /> oo N b. State <br /> v E <br /> C-4 R EPA/Other <br /> 0 <br /> A <br /> 00 T c State <br /> O <br /> R EPA/Other <br /> W <br /> F <br /> Z d. State <br /> W <br /> U <br /> W EPA/Other <br /> N <br /> Z J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> Oa. Qfyc�.�1T�t,���y1tsT 1'���syriot �r tir f�'t *� �uR��f .t s T�1�x`�`� <br /> U0 <br /> ►3nsr`•",s.4L�GS--�"+r"sM • CLGIL'!lV-W 1'ATMI4'lLS— a. 03 b. <br /> USM DRAWING NCMU pt?NDS d. <br /> JC. <br /> Z <br /> 0 15. Special Handling Instructions and Additional Information <br /> a (HAZ. BULK, DOHS "C" REQD) <br /> Z IN EVENT OF EMERGENCY CONTACT <br /> C.W.M.I. PROFILE #AJ-1871 <br /> W _ C.W.M.I. �� 12051 651-9221 <br /> r7 �; � '� T/ "C - T, 7� r , t� � / 9- Ill-~ �.(.. 1� <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 /> 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 t reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> a <br /> 0— economically practicable and that I have selected the practicable method of tr tment,storage, or disposal currently available to me which minimizes the present and future <br /> u7 threat to human health and the environment; OR, if I am a small quantity ge rator, 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 Signa �- Month Day Year <br /> Z T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> LLJ AAi Prin!e4/Typed Name � Signature r Month Day Year <br /> W r J 17 17 <br /> 0 18. Trans orte 2 Acknowled ement of Recei f of Materials <br /> W R <br /> T Printed/Typed f Name Signature Month Day Year <br /> 0 R <br /> � 19. Discrepancy Indication Space <br /> U F <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 /> f <br /> DO NOT WRITE 6ELCiW TH LINE. <br /> f Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 (.,1 <br /> DTSC 8022A (12/91) (Generators who submit hazardous waste for transport c- <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC <br />