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j. 200 39 (Expires 9.30-91) wte 0"K Ue re9e o Uepanmem of nea+tn 58rviosrs <br />Form designer! Mr use err Oddie (82 02 -pitch typ er), and Front of Page 7 Toxic Substances Control Division <br />Sacramento, California <br />+LF M HA D01 I 1• ator a us EPA ro No. Mantis 2. Page 1 <br />WAS E MANIFEST ClAd)l ga 111 13 Doc Information M the shaded areae <br />t of is not required by Federal law. <br />& Orator's Name and Mailing Address AM®fa <br />Si <br />5anta re Railwayr a UnCOln Avenue <br />Diamond st Worth Street, Stockton. CA 95206 <br />4. Generator's Phone ( ) <br />5. Transporter 1 Company Name 8. US EPA ID Number <br />n Erickson, . <br />a <br />is 7. Transporter 2 Company Name 8. US EPA ID Number <br />De�ig ted aclli am�Sit Add�rea fFac iy 4 1 , Barse US EP i�I Number <br />4 /O 740 Cast Carnegie Dr. <br />4 San CA 92408 <br />0 n <br />11, is IF <br />co 6 <br />tL 11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />Non RCRA Hazardous Waste Sn.l i s <br />E <br />3 N <br />E b. <br />A <br />T <br />O <br />V R C. <br />9 <br />M d. <br />12 <br />Z <br />W <br />0 <br />W <br />U% J. Additional tans fat ListOdMove <br />asoil S 1 <br />WDiesel 09bos <br />- <br />cc <br />J <br />Q <br />Z <br />16. Special Handling Instructions and Additional Information <br />Z Hour Contact; Nick Hardin <br />X 24 Hour Phone: (71) 386-4081 <br />LE <br />Transporter's ID ' <br />Slate, T } <br />6. StateilFty' <br />Faos to <br />—L-1 1 1 I <br />H. F ; Phone <br />phioni <br />12. Containers <br />No. Type <br />13. Total <br />Quantity <br />14. L <br />Unit Waste No. <br />Wt/Vol <br />gro <br />W <br />T <br />17. Transporter 1 Acknowle gement of Receipt of Materials <br />Z <br />R? <br />A <br />Printed/ peed` Name <br />SIg ti <br />eN <br />ti <br />P <br />�? <br />W <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />VT <br />Printed/Typed Name <br />SignAti <br />EPA/tither <br />E <br />sista <br />State <br />E1PA15&F— <br />HDRAftj <br />Codes for Wastes Listed Above <br />r' <br />G #, <br />J <br />J <br />U <br />GENERATOR'S CERTFICA - 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br />J and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and <br />national government regulations. <br />If I am a large quantity generator, I certify that I have a program M place to reduce the volume and toxicity of waste generated to the degree I have determined <br />4o be economically practicable and that 1 have selected the practicable method of treatment, store <br />present and future threat to human health and the environment; OR, If 1 am a small quantity ratan, have maor currently <br />agood <br />eptly faith effbleort <br />t me which minimizes the <br />generation and select the beat waste management method that is available to mr� and the ca atf�d, faith effort 4o minimize my waste <br />W0 <br />ype)1 Na e <br />Print Signet <br />(( <br />gro <br />W <br />T <br />17. Transporter 1 Acknowle gement of Receipt of Materials <br />Z <br />R? <br />A <br />Printed/ peed` Name <br />SIg ti <br />P <br />u 71-4 <br />i 1 '. <br />W <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />VT <br />Printed/Typed Name <br />SignAti <br />E <br />S <br />F <br />A <br />C <br />L <br />f 20. Facility Owner or Operator Certification of receipt of hazardous mat <br />T erials covered by this manifest except as <br />Y I Printed/Typed Name <br />DHS 8022 A <br />EPA 8700-22 <br />(Rev. 8-89) Previous editions are obsolete. <br />Do Not Write Below This Line <br />rm Day Year <br />Year <br />223 <br />19. <br />YELLOW: GENERATOR RETAINS <br />