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<br />State of C.lifornid—Envintuatental Protection Agency
<br />F,inT-Arapseved.OMB No. 20,40-00391Expires 9-3099) See Instructions on back ar 1e6. partmem of Toxic Substances Control
<br />Please pant or type, Farm designed kr a,a on erre (72-pilchl mite, �Q iii Sacramento. California
<br />DO NOT WRITE BELOW THIS LINE.
<br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS,
<br />DISC 8022A (1/99) (Generators who submit hazardous waste for transport out-of-state,
<br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)
<br />UNIFORM HAZARDOUS
<br />1. Generator's US EPA ID No. Manifest Document No.
<br />2. e I '
<br />f rmation in the shaded areas
<br />WASTE MANIFEST
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<br />notrirer FpdpEa
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<br />3. Generator's Name and Mailing Address
<br />A. State Manifest Document Number
<br />Nol�)%t�i� op I.Cllli,lean P!
<br />23318147
<br />3�IyV isii5i, A'.rPrhile !YI tx(.c':FJ: $UL, 151
<br />Side Generator's ID
<br />A. Gain ... for's Phone I j IS1 1332-6 315 Pa L.lttlts le, CA 9 3i ju
<br />[I'llgisliglij
<br />4
<br />5. Trarssporter I Company Name 6, US EPA ID Number
<br />C. State Transporter's ID [Reserved.]
<br />D. Transporter's Phone
<br />-
<br />7 iranspone 2 C spdny No 8. US EPA ID Number
<br />11
<br />E. Slate Trans orter Rse
<br />s ID. erves.
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<br />F. Transporter's Phone
<br />9. Designated Facility Name and Sim Address 10. US EPA ID Num6er
<br />G. SmtgTaciity's ID
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<br />EilsdA/'rDTLS 4tGSi t -;iii
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<br />I'l37 E. UerlTE1 'J C
<br />H. Facility's Phone
<br />Wi1RiiYi• t0h '::A S0744
<br />$10 835-9494
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<br />p'o (i g per Aping
<br />11. US DOT Description (including Pro Shipping Name,. Hazard Class, and ID Number)
<br />12. Containers
<br />13. Total
<br />14. Unif
<br />No.
<br />typeI
<br />Quantity
<br />Wt/Vol
<br />I. Wait. Number
<br />Waste Alkaline Cleaner, Non-RCRA Hazardous Waste
<br />State
<br />123
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<br />EPA/Other
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<br />6'
<br />RQ Haaar'dous 'wast@, solid, n.0. 5. f f;OI1C3iF15 '
<br />star.
<br />181
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<br />t-111'tDfll2O aCl 0 30Q LjaC 111711 1'l1tS: atL] ]'iA +ti'7'1, i
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<br />EPA/Other
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<br />6(; IiAS't';:f1c,',rt1le at:L+i Id01!lr3ra, II.oI�Taln� I:tu��mt'
<br />i Store
<br />792
<br />r'Id dltti t�Olc'is3 i11Ai herr :Gjt�lli d€'I, T, UNL'1tiS, {'C'li l,j� /t
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<br />EPA/Other
<br />J. Additional Descriptions for Materials Listed Above
<br />A: Alk. Cleaner
<br />K. Handling Cad for Wastes
<br />l
<br />Listed bove
<br />6: Acid Sol.ld Uebris
<br />a ��3
<br />b,
<br />C: Concrete slurry
<br />U: Acid Bottles
<br />03
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<br />15. Special Handling Instructions and Additional Information 62s 3tt9
<br />"EMERGENCV' 24 dour Contiket: (310) 332.2221 Gloves. Goygles, Protective Gear! 19: 616'/'32,
<br />t'nr manifest questions contact. Env. @ i;10! :fs.'.-692!4 Or ,314) 331-5600 C. 61.4989
<br />Mal l Addi ess 3:211 r.as1: Avenue hi. PAIL,' 4(, Pa'llfi lsy, CA 93S5() D: 616•/33
<br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are felly 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 6y highway according to applicable international
<br />and national government regulations.
<br />If I am is large qiiicuroiry genermoq I certify chat I hove program in place to reduce the volume and tojr- ity of waste g e ted to the degree I hove determined to be economically
<br />and that I have selected the
<br />Practicable pro cticable method o treatment, storage, o d0ji al current ya iloblhi co me which minimizes the present and Future threat to human health
<br />and the env ronme t; OR, if I am mall I hove faith'effort i 21"c'
<br />quantity generator. made a good Io astir generation and select the best waste management method that is
<br />available to and that I can afford. r m % �'1
<br />Printed/Typed Name )
<br />Signature / ��
<br />Mont Day Year
<br />/
<br />T17.
<br />Transporter I Aclax,viledgliument of Receipt of Materials --
<br />NPrinted/Type
<br />Namr / //tt 77
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<br />Signature?
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<br />Month Day Yeo. /
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<br />18. Transporter 2 Acknowledgement of Receipt of Materiels '
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<br />Printed/T ed Name.
<br />YP
<br />Signature
<br />Month Day Year
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<br />19. Discrepancy Indication Space
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<br />20. FacilityOwner or Operator Certification of receipt of hazardous materials covered b diEm this manifest exce 19.
<br />Printed/TYpd eI,! //
<br />SignoNra
<br />c
<br />DO NOT WRITE BELOW THIS LINE.
<br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS,
<br />DISC 8022A (1/99) (Generators who submit hazardous waste for transport out-of-state,
<br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)
<br />
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