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BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION LABEL OR ENTER: SITE NAME NESTLE BEVERAGE CO. RIPON, CA EFA ID NO. CAD LLL9 L1 8 9 1 0 OMB#: 2050-0024 Expires 9/30/92 eye eiA U.S. ENVIRONMENTAL PROTECTION AGENCY ik 1991 Hazardous Waste Report FORM IDENTIFICATION AND CERTIFICATION INSTRUCTIONS: Read the detailed instructions beginning on page 6 of the 1991 Hazardous Waste Report booklet before completing this form. SEC. I Site name and location address. Complete items A through H. Check the box B in items A, C, E. F. G, and H if same as label; if A. Please pint last name First name M.I. different, enter corrections. If label is absent, enter information. Instruction page 6 A. EPA 10 No. I I I e'ntY lama es label❑ «�� In. m Ilnin Ig j � � S J - C. Sitelcomtswy name I'-� D. has the see risme ass«ialed Wien this EPA 10 dti"ad aims IM? yl t Yes IL-J'r Same as lapel ❑ or — 2W E St est name antl n«nber. a ndl applicati enter industrial park, Wilding name «other phpical losation description. same as label ❑ or� 230 INDUSTRIAL AVE. F. City, town, Waage, etc. ❑ state G same as lapel ❑ , N Same�aaelabal ❑ pp SS Same ss label RIPON C � Y Y 161—I I I cr—ix best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties under Section 3006 of the Resource Conservation and Recovery Act for submitting false information, including the possibility of fine and imprisonment for knowing violations' SEC. II 1 Mailing address of site. Instruction page 6 A. Is the mailing adonis the same iss the lacafidn ad neer? 8J 1 Yes (SHIPTO SEC. 111 ) ❑ 2 No GOTOBOXa B. Number and weet name of mailing address a city, town. Wiese, em D. State E. Zip Cods I I 1 I I I 'IJ—I I I SEC. III Name, title, and telephone number of the person who should be contacted if questions arise regarding this report. Instruction page 6 A. Please pint last name First name M.I. B. Title C. Telephone activities of the site. Instruction page 7 A 1210191 1519191_ At 116111 MELING, JOHN L. PLANT ENGINEER Extension 9 EPA Form 8700-13A/B (Revised 8-91) - -- OVER --> Enter the Standard Industrial Classification (SIC) Code that describes the principal products, group of products, produced or distributed, or SEC. IV the services rendered at the site's physical location. Enter more than one SIC Code only if no one industry description includes the combined activities of the site. Instruction page 7 A a C D E10 19 15J I I I I I I I I I I 'I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a SEC. V system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the Information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties under Section 3006 of the Resource Conservation and Recovery Act for submitting false information, including the possibility of fine and imprisonment for knowing violations' A. Pleeu prMt used name Fina name MI. B. Title MELING JOHN L. PLANT ENGINEER C. sign lure D. Dale of signature T _ q, p T, 19 a ,2 1�bt0. Y IAYY v YR� a e o in 9 EPA Form 8700-13A/B (Revised 8-91) - -- OVER -->