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---F. --.„, —.- ----- — - ----- ---- <br />State of California—Env, onmental Protection Agency, <br />Form Approved OMB NJ2050-003 9{Expires 9-30-99) See Instructions on back c <br />;Please print or type. Fqm designed for uSe on elite (12 -pito vriter. <br />a <br />C� z <br />MC <br />N <br />`V1 ` <br />C <br />M Z <br />T�T3 <br />m cC <br />a <br />a <br />C, <br />c <br />c <br />t - <br />Ll <br />Ll <br />U <br />v <br />C <br />0 <br />0 <br />C <br />0 <br />c <br />1, <br />L <br />ge 6. Department of Toxic Substances Control <br />Sacramento, California <br />THIS WASTE STREAM HAS BEEN QUALIFIED <br />FOR RECYCLING/TREATMENT AT THE D/K <br />ffi"Yal,� <br />y,,��ACILITY IN VERNON, CA. <br />DHE NECESSARY PERMITS <br />WASTE STREAM AS QUALIFIED. <br />OUR EPA JICAT080033681. <br />DO NOT WRITe BELOW til <br />YEI:aO.: T DS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />produce completed copy of this copy and send to DTSC within 30 days.) <br />- <br />1. Generator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />_ <br />(FORM HAZARDOUS <br />is not required by Federal law. <br />WASTE MANIFEST <br />of <br />J Generators Name and Mailing Address <br />- <br />A. State Manifest Document.Number..: <br />22M <br />. 4 2B REBUI LDERS <br />B. State Generator's ID <br />2325 W. CHARTER {JAY STOCKTON,CA 95206 <br />4. Generator's Phone ( ) <br />9 t i- a <br />-- <br />5. Transporter 1 Company Nameb, US EPA ID Number <br />p <br />C. State Transporter's ID • - _ Y 1 _a -d 4 ., <br />D. Transporter's Phone' M <br />11' <br />1 I <br />7. ranspdrter ompany ame v r' s B. i1S PA DKum er <br />E. Slate Transporter's <br />w t.: <br />F. Transporter's Phone ` - 'r, •_ <br />9. Designated Facility Nome and Site Address 10. US EPA ID Number <br />G. StateF ility's ID <br />D/K Et�VIRONMENTAL <br />H. Facility's Phone <br />3650 26TH STREET <br />4 n <br />- <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and <br />ID Number) <br />12. Containers <br />13. Tota <br />Quantity <br />14. Unit <br />Wt/Vol <br />I. Waste Number z <br />No. <br />Type <br />' � v <br />State ,.... <br />' <br />HAZARDOUES ,WASTE SOLID N.O.S <br />G <br />(CADMIUM) 9, NA 3077, P.G.Il.I <br />EPA/other ,- <br />E <br />NNON <br />b, <br />Slate <br />E <br />RCRA HAZARDOUS WASTE SOLID <br />R <br />(EMILY SOLIDS) <br />Q Z <br />EPA/Other <br />kf 1 t <br />TC. <br />State; <br />p <br />NON RCRA HAZARDOUS WASTE SOLID <br />352 <br />R <br />(OILY DEBRIS) <br />n1 AA <br />Q 7, <br />EPA/Ott er , <br />d. <br />State ' <br />EPA/Other <br />J Additional riptions for Materials listed Above <br />K. Handling Codes for Wastes <br />...._ <br />Listed Above, <br />e300202-- 95 . - <br />- - - - -= <br />a - -. _ __ <br />3 <br />0 � _ <br />11 b. 36d 20 -02 <br />c <br />d . <br />11c. 3002 52. <br />15. Special Handling Instru ,lens and Additional Information <br />- •` -J'Q b7** <br />APPROPRIATE CLOTHING <br />24 HOUR tMERGENCY RESPONSE - CHEM TEL, INC. 1-800-255-3924 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this <br />consignment are fully and accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled; and are in all respects in proper condition for transport <br />by highway according to applicable internolional and national government regulations. <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 economically <br />and that I have selected the method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />practicable practicable <br />and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br />available to me and that I can afford, <br />- <br />rd/Typed ed N e jjj ( <br />�i�e yP d N L 1 o /- C—/Vu <br />Si nature / /` <br />O S IS / ,.-(jr'l-r--A/j <br />4ontIn Day Year <br />d <br />T <br />17. Trans or r 1 Acknowledgement of Receipt of Materials <br />R <br />A <br />S <br />Pri ed/Typ Namr. <br />N �v/o "-I 1 c c v <br />Si azure <br />i ; <br />onth Day Yeor <br />0 <br />P <br />0 <br />18. Transporter 2 Acknowled emenf of RIV't of Materials <br />T r` <br />B <br />Printed/Typed Name <br />Signature - ': <br />Month Day Year <br />E <br />R <br />j19, <br />A <br />iscrepancy Indication Space n I <br />C <br />f G I7D0� D v03� 1�vG� �' <br />- Z 'W <br />L <br />1 <br />20. Facili Owner or Operator Certification of receipt of hazardous mcAerials covered by this manifest except as noted in Item 19. <br />T <br />Pr fed/Typed Name <br />Signature <br />Month Day Year <br />'-e G 2 v <br />THIS WASTE STREAM HAS BEEN QUALIFIED <br />FOR RECYCLING/TREATMENT AT THE D/K <br />ffi"Yal,� <br />y,,��ACILITY IN VERNON, CA. <br />DHE NECESSARY PERMITS <br />WASTE STREAM AS QUALIFIED. <br />OUR EPA JICAT080033681. <br />DO NOT WRITe BELOW til <br />YEI:aO.: T DS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />produce completed copy of this copy and send to DTSC within 30 days.) <br />