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to of Cisgia"ils,and <br />-Form Approved OA4 -low 9-30L <br />'r -pitch Noswritod. <br />siso,j�fai or type. ffift 2 <br />gegW for s= F <br />UNIFORM HAWDOUS - 1. Generator's US EPA 0 No. ManifeW <br />I <br />WASTE IF ST nt Na.- <br />S. Generator's Name and MaWnfAZ;s—s <br />Santa 74 201"Y Co. <br />Pavand & 1. Worth Street, Stockton, Ca. 95205 <br />*''4. Generator's Phom(213) 267-5454�" <br />Sjansp;ew I C any ails 6. US EPA ID Number <br />7. Transporter 2 Company Nails 8. US EPA ID Number <br />Department of Services <br />Toxic Substances Control Division <br />Sacramento, California <br />2. Page 1 Information in the shaded areas <br />of I <br />I ] is not required by Federal law. <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />.j Chemical Waste Management, <br />0 <br />35251 Old Skyline BlVd. <br />Ke'AlIll ttlemain C1110 Ca. 93ifil" IT P P 1614 L1 .11 IL IP <br />12. Containers <br />11. US DOT Description (including Proper ShIppilia Name, Hazard Class. and ID Number) <br />No. I Type <br />a. <br />Waste Oil Contaminated Debris <br />G <br />E California Regulated Wap.� qn�j <br />g, a0 01911 ML - <br />b. <br />A <br />'R c. <br />Isetnictions,and Additional Information <br />cloves, Safety classes 870 062195-050 <br />13. Total14. <br />Quantity I unit <br />um <br />18. <br />this are fully and accurately described above by proper shipping <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of consignment <br />name and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable <br />.j <br />international and national government regulations. <br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have <br />determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to <br />me which minimizes the present and future threat to human health and the environment, OR, if I am a small quantity generator, I have made a good <br />faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. c <br />Pq%WTyped Name <br />Signature- Month Day Year <br />R, <br />TrimspMteu I Acknowledgement Of Receipt of Materials <br />Z <br />A <br />N <br />Printed/Typed Name r1n <br />- <br />Month" 06k Year <br />S <br />C. <br />0 <br />b <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />W <br />R <br />T <br />Printed /Typed Name <br />Signature Month Day Year <br />E <br />19. Riscrepancy indication ace g <br />F <br />A <br />C <br />ff <br />1 <br />20. Facility Owner or Operaipt of hazardous materials covered by thiy6 96if <br />M)Certification of race _- est except as noted in Item 19. <br />tt <br />YT <br />Printed/Typed Name <br />Signature Month <br />DM 8022 A (1/87) r INSTRUCTIONS ON THE BACK <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />EPA 8700-22 <br />(Rev. 9-436) Previous editions are obsolete. <br />