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•ate of Californio—Environmemol Protection Agency <br /> approved OMB No,20'0-0039(Expires 9-3694) See Instructions on back of page 6. Deponment of Toch S,bstances Control <br /> 'print or tyFe. Form designed for use on elite(12-pitch)typewrite, Sacramento,California <br /> I 1, Generator's US EPt,ID No, Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST 1 1 9 4 0 0 6 1 of 1 <br /> 3. Generator's Name and Mailing Address ZUCKERMAN—MANDEVILLE, INC. A. State Manifest Document Number93164427 <br /> I 111 ZUCKERMAN ROAD <br /> STOCKTON, CA 95206 B.State Generators ID <br /> A. Generator's Phone ( ) _ 5 10 14 14 19 <br /> t <br /> 5. Transporter 1 Company Name 6. US EPA ID Number .–tate'Transporters IDt` y <br /> DILLARD TRUCKING CAD 9 8 1 6 9 2 8 0 9 D. Transporter's Phone ((510) 634-6850 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporters ID <br /> 1 <br /> I F. Transporter's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G.State fvcildy's 10 <br /> STATEWIDE ENVIRONMENTAL <br /> 12618 MAIN STREE7I' tai <br /> H. Facility's Phone <br /> IIAS ANGELES CA 90068 ICIAIDIOIOIOIO1818121512 (213) 756-7896 <br /> _ 12. Containers 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. I Type Quantity Wt/Vol I. Wade Number <br /> I NON RCRA HAZARDOUS WASTE SOLID st 22 <br /> G (OILY DEBRIS, EMPTY CONTAINERS & BATTERIES) D M 5 p P EPA/Other <br /> b NON RCRA <br /> WASTE COMPRESSED GASES, FLAMMABLE, N.O.S., 4 s'a'e <br /> R 2.1 , UN1954, (USED AEROSOL CANS) D F O0 o P EPA/Other <br /> 6001A <br /> 7-1 <br /> RQ, WASTE BATTERIES, WET, FILLED WITH ACID, 181 <br /> ` <br /> 8, UN2794, PGII (D008 & D002) IR0144DO p EPA/Other <br /> J d sbte <br /> J <br /> EPA/Other <br /> J <br /> �• y A �� (( j{ Gag Codes for Wastes Listed Above <br /> d. <br /> j15. Special Handling Instructions and Additional Information 24 HOUR EMERGENCY RESPONSE NUMBER 1 (800) 399-4357 <br /> 11A. PROFILE #15632 VRrr#a <br /> 11B. PROFILE #15109 (EMERGENCY RESPONSE GUIDE #22 ATTACHED) <br /> 11C. PROFILE #18170-1 (EMERGENCY RESPONSE GUIDE #60 ATTACHED) <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> tpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,date and international laws. <br /> J <br /> If I am a r 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 <br /> econo is practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and fur--re <br /> thr to man health and the environment;OR, if I am a small quantity enerater, I have made a�aad faith effort to minimize m waste generation and select the best <br /> i wa no ment method that is available to me and that I can afford. <br /> �N BEHAIJF OF ZUCKERMAN—MADIDEVILLE INC. <br /> PrW4 Stgnahs�� � � / � _ Month Day Year <br /> 19 11 11 1 <br /> 17. 71ionsl 1 Acknowledgement of Receipt of Materials <br /> �N Printed/Typed Name Signature 6Month ) Da j � <br /> WYear1 <br /> 6 a ty o 4 <br /> 18. Transporter 2 Acknowledgement 01 Receipt of Materials <br /> J Printed/Typed Name Signatvro Month Day Year <br /> U 19. Discrepancy Indication Space <br /> i <br /> l <br /> L <br /> 1 20. Facility Owner or Operator Cerfificafion of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> White, TSDF SENDS TH15 COPY TO DTSC WITHIN 30 Dt,�` <br /> DI 8022A (7/92) To. p.0 Box 3000 Socrament-e CA 95812 <br /> :PA 8700-22 <br />