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A <br />4 <br />—7 <br />StotC r. <br />aliforni' -Erwironmentot Protection Agency. <br />I <br />Form loved OMB No. 2050-6039 (iExpirps 9-3044) 1,1-?# <br />P( rty%e 'N2-pitc <br />6-.•rr F.km dei$he06r us& Oiik� - life <br />See Instructions on back or -aqe 6 <br />DO NOT WRIT LOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />DTSC 8022A (A/97) produce completed copy of this copy and send to DTSC within 30 days.) <br />EPA 8700-22 <br />Sacramento, California <br />i. 6enerotor's US EPA ID.No. Manifest Document N— 2. Page 1 Information in the shaded areas <br />UNIFORM HAZARDOUS is not required by Federal low. <br />0?3 <br />il-.1 <br />WASTE MANIFEST <br />11 <br />9_t Ll <br />Generator's Name anti Mailing Address <br />A. State Mani esl Document Number <br />972`5 2 <br />OBR REBUILDERS <br />B. State Generator's ID <br />2325 W CUAR7R WAY, STOCKTON, CA 9512-06 <br />4. Generator's Plone <br />t 209' 4,67-0490 <br />1 1 1 1 1 1 1 1 1 1 1-1 <br />5. Transporter I Company Name 6. US EPA to Number <br />C. State Transporter's ID <br />D. Transporter's Phone <br />ba A 1 5 'A 14 14 in I <br />7. Transporter 2 ompanyTJame y —8.'OSEPA ID Number <br />E. State Transporter's ID <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />CHEMICAL WASTE MANAGEMENT, INC. <br />IA 4 10k ILL Ll I) It 1�� <br />H. Facir,-r7-sPhone <br />35251 OLD SKYLINE ROAD, KET-I'LEMAN CITY, CA 93239 <br />h IA I!7P b k7l h IA 11 11 <br />t . fr)na) .. <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />Containers <br />12. Containers <br />13. Total <br />Quantity <br />-- <br />I '.—U.it <br />Wt/vol <br />I. Waste Number <br />— <br />No. <br />Type <br />Type <br />a. <br />State <br />WASTE CORROSIVE SOLID, N.O.S.9 8, UN17591 Iii <br />1 sl <br />EPA/Other <br />G <br />(SODIUM HYDROXIDE) NAERG96#154 <br />A <br />E <br />N <br />6. <br />State <br />E <br />R <br />EPA/Other <br />A <br />T <br />C. <br />State <br />0 <br />R <br />EPA/Other <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions fo,.Materials Listed Above <br />K. Handling Coces: For Wastes <br />Listed Above <br />V4 <br />c <br />d . <br />15. Special Handling Instructions and Additional Information <br />-QSa/SAIZA <br />HANDLERS BE 40 H%JR TRAINED. <br />AND USE NIOSH APPROVEP,.PPE.., <br />P, <br />EMERGENCY 0QNTACr:-,(916) 371—�747, <br />16. GENERATOR'S CERTIFICAT16N."A hereby declare that the cQne-ints of this 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 by highway according to applicable international and national government regulations. <br />' <br />If I am a large generator, I cerfi� that I have a program in place to reduce the volume and toxicity waste 9%,erotecl to the degree I have determined to be economically <br />w to hum 'K <br />disposal currently availabletome ch minimizes the and future threat an health <br />practical:il� nd I have selected the rracticable method a treatment, storage, or present <br />hot of <br />that <br />and the environment; OR if I am a -smo I quantity generator, I have made a good faithot to minimize my waste generation and select the best waste management method that is <br />ovaila6le to me and that i can af6rd. <br />Printed/ Fed Name Signature Month Day Year <br />T <br />)7. Tro'nspeAcfmowledgmeritof RereiptrbfV.17.1, <br />Printed/Typed Nome <br />ignatu, <br />Vonth Day Year <br />N <br />PL <br />0 <br />--181 Trans p6ri'lisir 2 Acknowledgement of Receipt of Materials <br />t' <br />T <br />Printed/Typed Nome <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />1 <br />20. Facili wrier or perator Certifi"tion of receipf ozord6us materials covered by this mcmifest eacept as noted in Item 19. <br />T <br />Pri;nted�l!pecl Name <br />Signature <br />Month Day Year <br />Y <br />DO NOT WRIT LOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />DTSC 8022A (A/97) produce completed copy of this copy and send to DTSC within 30 days.) <br />EPA 8700-22 <br />