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State of California—Environmental Protection Agency <br /> IU-1 (� CCVM <br /> 5orm Approved OMB No.2050-0039(Expires 9-3094)i, See Instructions on back of - 'e 6. Departq nt a Toxic Substances Control <br /> Please print or type. Form designed for use on elite(1�-pitch)1 ter. - ' Sucre ento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Informd on in the shaded areas <br /> snot r} vire by Federal law. <br /> WASTE MANIFEST <br /> �'C�AID1010191211121912 19 `, ,J of 1 <br /> F1 3. Generator's Name and Mailing Addresi A. State Mar ifest Docun mst <br /> STOCKTON PLATING INC I .. �} < <br /> 632 S. EL DORADO STREET <br /> STOCKTON CA 95206ID- <br /> h 4. Generator's Phone (209) 948-1 1 0 1 <br /> ap <br /> Op' 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporters ID <br /> TRI-STATE MOTOR TRANSIT IMIOID1019j510131891918 D. Transporter's*— . (209)386-6251. <br /> -Jr 7. Transporter 2 Company Name 8. US EPA ID Number E. Stall Transporter's ID :f y+,t. ;?v'✓ `^ '�?,•; <br /> F. Transporter's Phone } c <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Fodlitys ID <br />=Z CHEMICAL WASTE MANAGEMENT, INC. <br />�0 35251 OLD SKYLINE ROAi� H.01 <br /> 35251 <br />�Q KETTLEMAN CITY CA 93239 CAT 0 0 0 6 4 6 111 7 (249)386-97,11 <br /> U12.12. Containers 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) r• <br /> Z No. Type Quantity Wt/Vol . Waste Number <br /> a. HAZARDOUS WASTE, JN.O.S. qt State 181 <br /> (CHROMIUM, LEAD)I,9,NA3077, I I I 9 <br /> G <br /> N E ' ' !yl C C: O1-IPA/Other <br /> CD <br /> 000 N b. State <br /> 00E <br /> R EPA/Otlxr <br /> A I state <br /> 0 T C. <br /> O <br /> EPA/Other <br /> 0:: R <br /> w <br /> Zd. Stara <br /> LU <br /> U EPA/Other <br /> LU <br /> c� <br /> !+ <br /> J. Additional Descriptions for Materials UsW Above K. Handrmg Codes for Wastes Listed Above <br /> a l a. BF-9654 a �Q/b b <br /> w �+ 1 <br /> C. d. <br /> J <br /> Z <br /> O 15. 5 ecial Handling Instructions and Additi nal Information <br /> CW['� Emergency Response Information (800)765-8713 <br /> a y <br /> Z <br /> LU iG 6 <br /> 16. GENERATOR'S CERTIFICATION: I ereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Qpacked,marked,and labeled,and are ii�all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> V <br /> If I am a large quantity generator, I c rtify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment, storage,or d,sposol currently available to me which minimizes the present and future <br /> CL threat to human health and the environ ent; OR, if I am a small quantity generator, I have made a-eood faith effort to minimize my waste generation and select the best <br /> N <br /> waste management method that is avoila le to me and that I can afford. <br /> Q Printed yped Name Signature / 1 ) Montes Day; ,Year <br /> U T 17. Trans orter 1 Acknowledgement of Receipt of Materials <br /> W R <br /> 0A Print /Typed Name Signature `, Month Day Year <br /> OC 5 fl c 1. / / / <br /> W p <br /> 0 18. Transporter 2 Acknowledgement of Recei t of Materials <br /> U , Printed/Typed Name Signature Month Day Year <br /> LL E <br /> Q R -711111 <br /> LU 19. Discrepancy Indication Space <br /> N <br /> Q F <br /> U A <br /> ZI C <br /> L <br /> 1 20. Facility Owner or Operator Certification f receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> ! 'r Printed/Typed Name _ Signature Month Day Year <br /> Y r <br /> ( DO NOT WRITE (BELOW THIS LINE. <br /> "eilow: TSDF '_S THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (7/92) Gene' ,vho submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 q �r n 'f r produce completed copy of this copy and send to DTSC within 30 days.) <br />