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Sky, d Ccilj�,,II )Iedh aid Welaw Agency Depart a of Health service, <br />See Inshuctlons on bOCK of6. Toxic substatcef Cormol Program <br />Pow pro aype <br />t. Fomr W>{ryu <br />d for i, on ft (1rz 7'dreh Sacramento. Caomia <br />=: r Do NOT WRNE BELOW THIS UNE. V - <br />+ y ` <br />^r \ <br />VM 11022A 610907 "'� : Green HAULER{2ETAINS <br />EPA <br />r + <br />YWh�+'•Y114iYlii+t�e, I,Bixn,"•,�:r.:urrar t-.wir,:a. F+.•A&e...;; II .. :.S.r,J .1,�,:.: ,r ,:afar ve!gx. <br />UNIFORM HAZARDOUS <br />Generaloff LIS EPA ID No. <br />Mantest Document No. 2, Pape 1 <br />reformation In the shaded area <br />WASTE MANIFEST <br />71 i 1 <br />( IZ i of <br />Is hot req,"edhYFederallo"` <br />nwatoM1 and MaYkq Ad M <br />0. State Mbnteft ument Num j 'y �y <br />�1��154-3 <br />Ari LLIWrC/^(C, ���� r�i )0 <br />ate C.erer off <br />rz <br />Q UarupoAer 1. Canpary Nome <br />0. US EPA ID Number <br />C.SfTJt4Tmrw&pomars Itt <br />Al lief Petroleum <br />L A IJ 19 18 IU 16 I IS 11 1213 <br />D,<T-wrteelPh-,o <br />7. Trorporef 2 Cornpory Name <br />S. 175 EPA ID Number <br />E 51ate Trarnporh e.ID <br />F Tran eh Phone <br />I I I I I I I I t I <br />9. Derlgu Efsltiv.lJon+a ar� SltsAddresf <br />10. US EPA ID Number <br />G Eoc"py{� <br />Srle.. )... <br />i <br />1333 N MY 33 Patterson <br />1 <br />H, Facts a Phone s <br />CA ASIA <br />I a 1,4 I [1 I� i I I'• <br />,�. <br />12. Contairen <br />IJ. Told <br />14 uMt <br />11. US DOT De"erpti n (InckWq Proper Shlppkq Name. Haard Cbz, and ID Number) <br />Ouonl <br />W17No1 <br />I. Wote Numeer <br />No. <br />7 <br />a <br />State <br />NO'S NA 19511 <br />c23 ' <br />c <br />E <br />TIT <br />l <br />v <br />1 11 <br />t <br />E <br />R <br />A <br />T <br />c <br />State <br />O <br />R <br />I I <br />I <br />I I I 1 <br />EPA/Other. <br />G <br />I I <br />I <br />I I I I <br />hate <br />Above <br />K: Horglinp, <br />odea fOr WWOS Uted Atave <br />Sy� ggM.�y�rqk:�Lilacl <br />:�iyky{y Y <br />F111119 RL4 PIP IV ILLI tYI 6LAR <br />DESI MTEI) FACILITY EALkGENCY CUNIACT t (WQ)674-4444 <br />"AATOA ENEXIAENCY LONTACT <br />lA GENERAM" CEIMFICATION:I Mreby declare that the contentf of the consignment are fulty and a ufc tety defcnbed above W proper shlppbc roar» and are nlusEkd. <br />Pooee4 moped, and IoW W, and rn In of refpects In proper conthon for pompon by highway occordng to opp"cable Mematkxtd and notional povermterd mgulakxs <br />M I am a birgCQuar"y gerwUor, I certify thot I hale 0 pogrom In place to reduce the volume and tox" of warts generoled to the degree I have determned to be <br />ecortomiDc l/.pacticable and mot I have elected the prachcabe method of treatment, storage. or deposd curtentN awlbbie to me which rNnlmFos the present and future <br />f wea to human health rnd the erMromwM: OR. P I an a mall quntM ger»mfa, I ham made a good fatth effort to minimize my w e generation and select the bed wcste <br />ma ogehw* method ttcli aMubM to me anal that l con afford. <br />PrYRed/Typed Name p&.4 A..n <br />Signature <br />Monm Rry Yea <br />iC. .0 nuo <br />t f <br />I! I! rt 17 <br />T <br />17. TraspoAer I. AckrFAAedpemenl of Receipt of Moerbe <br />R.: <br />PIVd d/TytMd <br />91pAalue .! <br />Month Dal' year <br />A <br />N <br />._ <br />�: <br />s: or dMalenlaf <br />R. <br />AVvWffyped'Nbrift .. <br />s -..+ <br />Monm Day Yeo <br />t <br />E; <br />I I I I I <br />F. <br />19e,DYtlWpdnLy YkloaIN Spar» <br />A <br />.w <br />L <br />I._.. <br />21 FocMy. ;tlr Operelor.Oeltftatlon of receipt of t=adou moterlalf covered by the rrcr~ except ce noted In Hem 19. <br />T,'. <br />ypeO'Name <br />Signature <br />Monm Day Yeo <br />yll <br />r' <br />19 - <br />=: r Do NOT WRNE BELOW THIS UNE. V - <br />+ y ` <br />^r \ <br />VM 11022A 610907 "'� : Green HAULER{2ETAINS <br />EPA <br />r + <br />YWh�+'•Y114iYlii+t�e, I,Bixn,"•,�:r.:urrar t-.wir,:a. F+.•A&e...;; II .. :.S.r,J .1,�,:.: ,r ,:afar ve!gx. <br />