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P<- <br />State of Colifornio-�nvironmw*oj Protftlion AgencyI& <br />C� <br />Ill Appilovel 3 94) See <br />, tAB No. 2050-OW9 (Expires 9 - <br />Home print or type. F. designed for . on eke () <br />UNIFORM HAZARDOUS Cienerators LIS EPA ID No. <br />WASTE MANIFEST <br />PGAnorrccl Nr Ind M.�ifh <br />Ad <br />S 4 (!s ve <br />C4 <br />on 4. Generator's Phone 9- 0?_ <br />T" AtI — ? �. I AL <br />Of - I., -,/ <br />7 <br />9.- Designated Fol Name and Site Address10. US EPA ID Number <br />Gibson Oil / Pilot P*trQle'um <br />475 Sea Port Blvd.ji <br />Dal of Toxic Sbstonces Coll <br />S—r-1 California <br />Information in the shaded areas <br />is not rewired by Federal law. <br />1—t— r Company Nome <br />EPA ID Number <br />1_2 <br />RQ Hazardous waste Liquids pos oRm E <br />_j <br />ir jok <br />7. Transporter 2 Company Nam <br />—1c I A 4 <br />8. US EPA ID Number <br />NA9189 D018 <br />TMonth Day <br />Year <br />"112 <br />9.- Designated Fol Name and Site Address10. US EPA ID Number <br />Gibson Oil / Pilot P*trQle'um <br />475 Sea Port Blvd.ji <br />Dal of Toxic Sbstonces Coll <br />S—r-1 California <br />Information in the shaded areas <br />is not rewired by Federal law. <br />Reims <br />Of Receipt of Materials <br />1_2 <br />RQ Hazardous waste Liquids pos oRm E <br />G <br />NA9189 D018 <br />TMonth Day <br />Year <br />"112 <br />I E <br />7, <br />iN <br />E <br />1,� 12 1 Vj <br />R <br />LU <br />• <br />A <br />M <br />T <br />0 <br />nol TR <br />U. <br />R <br />Printed/Typed Name <br />Signature <br />Month Day <br />Year <br />0 <br />Mt <br />4 <br />A <br />F T, <br />z <br />Z- <br />U.1 <br />15. Special Handling Instructions on. <br />and Additional Informal <br />Gibson Oil Waste,Stream Prof Ile I N'01 ERG 31 <br />U <br />24 Hra Contact, ­/ 24 Hr Phone- <br />16. GENERATOR'S CERT1114CAT11,01% I hereby declare that die contents of he consignment are fully and accurately closcribed obo by proper shipping and are classified, <br />pocked, marked, and lobel and are in all respects in, proper condition for transport by highway according to applicable federal, date and international laws. <br />C <br />If I am a large quantity generator, I certify that I how a program in place to reduce the volume and tol of waste generated to the degree I have determined to be <br />economically practicable and that I have selected the predicable method of treatment, storage, or disposal - to me which minknizes the present and future <br />I <br />threat to human health and the environment; OR, I I am a small quantity generator, I have made a good f= mize my waste generation and select the best <br />waste morl method " is available to me and that I can afford. <br />—Tranymder 1 Acknowledgement <br />Of Receipt of Materials <br />TMonth Day <br />Year <br />"112 <br />1Aj <br />:* <br />-MAI <br />1,� 12 1 Vj <br />LU <br />0 <br />It <br />18. porter Trans <br />— 2 Acknowledoement <br />of Real of Materials <br />U. <br />Printed/Typed Name <br />Signature <br />Month Day <br />Year <br />0 <br />U.1 <br />19. Discrepancy Indication Space <br />U <br />IF <br />A <br />C <br />I <br />L <br />1 <br />20. Foal Owner :, 1 1! 1 Seqjqcohon of receipt of hazordous materials covered by this manifetst3exe noted Nem 14. <br />Ty <br />Printed/TyLxsd t4ame <br />Si I <br />ffionth <br />DO NOT WRITE BELOW THIS LINE. L/ <br />DTSC 8CL22A (12/91) <br />EPA 8700*_ <br />