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,Mate oLColifornia—Environmental Protection Agency vvml <br /> form Approved OMB No.2050-0039(Expires 9-30-9 ] See Instructions on back of F 6. Department of Toxic Substances Control <br /> Pleas ftrint or type. Form designed For use on elite(1 pitch)typt—ter. Sacramento,California <br /> UNIFORM HAZARDOUS ) Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST 5 j of I <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number ^ <br /> Yst .'r1\,4'J•` ��:�._.Il Vl�rff`!C_iitiL.` 13 _ r�) 1 <br /> $32 S EL C ORAS ) �T <br /> o STOCK rCJN ti, 521 . Q r B. State Generator's ID <br /> n4. Generator's Phone ( 209 911$11C1 f <br /> (V 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved] <br /> o PHILIPS 1RANSPORTA'TICN RE DIF�Ti0Il`I SVCS. C +, D 0 51 ,5141719 h D. Transporter's Phone (£100).321-1030 <br /> oD 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.) <br /> F', Transporter's Phone <br /> U 9. Designated Facility Name and Site Addr s 10. US EPA ID Number G. Stale T'1­11rtl�`j <br /> CHEMICALWASTE NAANAGEME . INC <br /> 00 35251 OLD SKYLINE ROAD H__Foc Pity's Phone <br /> _ KETTLEMAN CITY CA 93239 1 C-1 AlT 10 10 0 1 6 14 fi 1 11 1 LL <br /> ? (559}3$6 9711 <br /> Q <br /> 12. Containers 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Sh pping Name,Hazard Class,and ID Number) <br /> U No. Type Quantity Wt/Vol I. Waste Number <br /> Z a- 1100 RCRA HA ARDCUG A, .'STE SO`LIC1. State <br /> = 161 <br /> i PAINT DULST AND PUYURETi E FLOOR <br /> ~ SWEEPINGS ,M-n!PVI-7,kSj EPA/Other <br /> o b' State <br /> N <br /> cOooE <br /> EPA/Other <br /> 4 Rv 9 c State <br /> o T <br /> ao O EPA/Other <br /> R <br /> State <br /> LU d. <br /> lZW1 EPA/Other <br /> LU <br /> V) J. Additional Descriptions for Materials Listed Above - K. Handling Codes for Wastes Listed Above <br /> Z <br /> 0 8.E 'L55:a' <br /> a. b. <br /> LU <br /> y c. d. <br /> J D <br /> Q <br /> Z 15. Special Handling Instructions and Additio al Information <br /> O <br /> Q CHENi?REC Er,lenjanry ROSPOnse f.urnbt)r(900)424-9300 W1o11 Cmtrsct <br /> Z <br /> LU <br /> 2 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all resp cis in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantity generator,I certi 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 /> d practicable and that have selected the p acticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <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 /> ck: available to me and that I can afford. <br /> 0 t <br /> r Printed Typed NameSignature Month Day Year <br /> } r <br /> w T 17. Transporter 1 Acknowledgement of Recei of Materials <br /> ce R1 <br /> w p frr it�d/Typed Name Signatu,` t Month Day Year <br /> P `! .l1('� C, <br /> r.� 0 18. Transporter 2 Acknowled emeeof Receipf of Materials <br /> 0 TR Printed/Typed Name Signature Month Day Year <br /> w E - <br /> v7 R <br /> (Qj 19 Discrepancy Indication Space <br /> Z F <br /> A - <br /> C Z. <br /> L !t/ <br /> 20. Fad ity Ow or Operator Cer ficoti .o reLei t of hazardous materials c v re?l b_y this mon'fest exce t as noted in Item 19. <br /> jPrWstetl�ype ame Si tura "` "Month - D y Yeor <br /> DO NOT RITE BELOW TkIIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) (Gen ators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 uce completed copy of this copy and send to DTSC within 30 days.) <br />