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ate of California-Health and Welfare Agency Department of Health Services <br /> Toxic Substances Control Division <br /> ,�L / /� L• Sacramento,California <br /> lease print or type. (Form designed for use on elite(12-pitch)typewriter I e A a;-1 <br /> UNIFORM HAZARDOUS 1.Uenerator's U9 EPA ID No. Manifest 2.Page Informationinthe shaded areas <br /> WASTE MANIFEST C A D .0 .0 .0 .8 1. 9. 8. 2. 1 Document No. of 1 isnotrequired by Federal <br /> Generator's3. Name and Mailing Address Symtron Corp. A.State Mart,jfebt 2727 <br /> umentNumber r� <br /> 2235 Mora Dr. 8E ``//t1t 77�Z l]2 7 <br /> Mt. View, CA. 94040 B.State Generator's ID HQ36-'009061 I <br /> 4. Generator's Phone ( 415 ) 965-4500 CAD000819821 <br /> 5. ranspoNer 1 Company Name 6. US EPA ID Number C.StateTransporter's ID c4 > ,/ <br /> Chemical Transfer Co. A •D •0 -0 4 7 -7 1 6 -0 .E D.Transporter's Phone:1 <br /> c f <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E.State Transporter's ID <br /> . . . . . . . . F.Transporter's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. tate Facility's ID <br /> Southern California Chemical CAD008488025 <br /> 8851 Dice Road acilirys Phone _ r <br /> Santa Fe Springs, CA. C. A D. 0 0. 8. 4. 8. 8 0 2 5 <br /> 213 698-8036 <br /> 11.US DOT Description(Including Proper Shipping Name, Hazard Class, and ID Number) 12.Containers 13. 14.Total Unit <br /> G <br /> No. T e Quantity /�/pl Waste No. <br /> E a.Copper Chloride Solution (RQ 30/4.54) <br /> E Corrosive Material D002 <br /> E <br /> R UN2802 I T TP 0 1 7 o,n111 <br /> A b. <br /> T <br /> O <br /> R C <br /> C. <br /> f <br /> d. <br /> J. Additional Dewiptlons for Materials Listed Above K,Handling Codes for Wastes Listed Above ` F <br /> a) Water, Hydrochloric Acid, and Salt/Oxidizer. Mixture C <br /> with 24-27 oz/gal Copper 03 <br /> Special Handling Instructions and Additional Information <br /> Wear Goggles, Gloves Apron and Boots. <br /> 16.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignmerx are fullyand accurately described <br /> above by proper shipping name and are classified,packed,marked,and labeled,and mein all respects in proper condition for <br /> transport by highway according to applicable international and national governmental regulations. <br /> Date � <br /> Printed/Typed Name Signature Month Day Year <br /> 1` Ron De Hooq ' 0 18 7 <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> Printed/Typed Name Signature Month Day Year <br /> a ` C' l . 3 .? i. l <br /> P <br /> 18.Transporter 2 A6knowledgement or Receipt of Materials Date <br /> T Printed/Typed Name SignatMonth Day Year ti <br />.E <br /> 4 <br /> 19.Discrepancy Indication Space <br /> F <br /> 20.Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in f <br /> T <br /> Y Item 19. i. <br /> Date <br /> Printed/Typed Name Signatut* ` Month Day Year <br /> White: TSDF SENDS THIS COPY' DOHS WITHIN 30 DAYS <br />-IS 8022 A (7/84) Tl1- P 0 Ftp; 100_ .,. , mento. r.A 95812 <br />