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Stora al�CaliloMkio--Enviranm mm[Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9.30-99) See Instructions on back oftge b. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch)typewriter. <br /> ' Sacramento,California <br /> UNIFORM HAZARDOUS TTG.n..r.Ior',US EPA ID No. Manifest Document No. 2. Page I Information in the shaded arses <br /> WASTE MANIFEST not required by Federal law. <br /> AscC C 4 of <br /> 3. Generator's Name and Mailing Address IE`'ERGENCY, SEE BOX )5) A. State Manifest Document Number <br /> DEPILly ORT3.7TELN 20303077 <br /> h 1159 N. P4-CARTI-CR ,TPACli CA S:537-6 B. Stow Generator,ID <br /> 47) 4. Generator's Phone I 477N. CL411 T• SLI-IEN lElX1 El NIPI . <br /> h5. Transporter 1 Company Name 6. US EPA ID Number C. Srote TramporlMs ID[Reserved <br /> m <br /> D. Trgnsporler's Phone <br /> $ 7Y I£IEEv (7a); INC. S JR121,31312 7 § 1511513 <br /> 036) 37`rZ611 <br /> m 7. Transporter 2 Company Nome 8. US EPA ID Number E. Store Tramparter's ID IResery .]'. <br /> a J � ESv3 RCs3air�E3v7#a�. r` y, {t '.LA .� '� F. Trampartars Phone (M) <br /> V <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Fxi iy/a ID <br /> y):5 SWETY KLEEN (94RWXl1 )5 3:,;C, <br /> D O 13683 NORTH APTLS RDAD H. Facility?.Phone <br /> iY)LL c117 A d - t <br /> .. <br /> Q 12. Conbinen 13. Tobi 14. Unit r <br /> V <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type 13. Totantity Wt/V.1 I. Waab Number <br /> V Z L( l l O- F ok , $tete <br /> UI 3W2 I fG� <br /> 3 � ///yyy <br /> o N b' givP45. f- "4 1Y1011G/ a4- G 1� /� I//� 'St° -.... <br /> N ER ryhi i a. <br /> LW31 <br /> ���1 II QCL IJ V I A Other <br /> NV A <br /> T D. <br /> Q g ygjaama7a >l�Q /A.d.t, p` State 3 <br /> GO R /J ,,t� PylL�e-)� )j f'I/w1-[�/3y C,� I Q�-Lbpi ® t EPA &r gt <br /> W <br /> d. r) cPnp�or�cc� cu( sf4cc a C' $ate <br /> v WJ 321a4f �t�L 16(rLt S l�4 B 2 er a <br /> W <br /> 1. Additional DeuH Iia s r all Lia) e K Hardling Codes for Wastes.Listed Above <br /> gZ -1W2VI& 1 IXS � 3341._-��� e. <br /> 212�Gai it1�y(--td 1 <br /> Q I,Q"3flr3212 � R1ChS +1/'•' 1T�iQa` 3i r33 CJ c. d. <br /> ZL IPA 2 <br /> O 15. Special HandlingIrMructiomand ddilional reformation 31' L;+s37EL3VE%WaLE, RETURN TO BEXERA70R. IN EMEREEICY, <br /> Z ML 3-E @ 1-d -468-176a 0ZS- M). AV03D CCjVJRC7 AWD DEAR ARVTECT31JE FEAR. <br /> w <br /> DOT EYERC-ENCY RESFC&% &JI EE ECC)4 14 ERS. 13a+6-' 3]b)/212 / 331 jZ? 13d)lPf <br /> fS 3DM D 4 3 t&3i«8 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurces described above by propershipping nomeand ore classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport Oy highway according to applicable international and national government regulations. <br /> r <br /> If I am a large that <br /> generator,I certify that I have a program in place ro reduce the volume and toxicity of wase generated im thezes degree I have determined ro to human hal <br /> a <br /> ,ad <br /> en and that I hwe selected the practicable method of treatment,ma e a goo,or disposalfor currently available ro me which minimizes the present and,future <br /> man geniehreat t human health <br /> as and the environment; at I if 1 am a small quantiy generator,I have made o good(pith effort ro min' ' a m ro generation and select the bast wase management method that is <br /> as available ro ma and deaf can afford. <br /> 0 <br /> r y Prined Typed Name r Signature Month Day Year <br /> U .ars ti^C n I 4 0 <br /> 3 T 17. Transporter 1 Acknowlodgement of Receipt of Materials <br /> A Pri ted/T ad N Si, Menth Da <br /> w R l/sk <br /> w S 14 <br /> LL 0 18. Transporter 2 Acknowledgement of Receipt of Materials I <br /> O T Printed/TYped Name Signature Month Day Year <br /> W IR <br /> 19. DiscrepancyIndication Space <br /> Z F <br /> _ A <br /> C <br /> I <br /> L <br /> l 20. Facility Owner or Operator Ce tiRmtion of..i t of hazardous materials covered by this manifest except as noted in Ilam 19. <br /> T Prinwd/Typed Nam. Signut.re Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Whir.- TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P 0 goo 300, Socmien•n. CA 95312 <br />