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State of California—Environmental Protection Agency,,' <br /> Form Approvgd OMB No.2050-0039(Exp"ii'es 9-304?) See Instructions on back of a 6. Department of Toxic Substances Control <br /> Please_print or type. Form designed for use on e1ite jf''2•6&h 'ter. Sacramento,California <br /> UNIFORM HAZARDOUS nerator's US EPA ID No. Manifest Document 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> EST <br /> WASTE MANIF �CJAIL1010101 .1,1214131312101 4of <br /> 3. Generator's Name and Mailing Ad rensA. State Manifest Document Number <br /> O _ . 3- <br /> 1305 E. VINE STREET, WDI y CA 95240 B. State Generator's ID <br /> OOq ,✓ y <br /> A. Generator's Phone( 2 ) .331"'71*T 1t%' <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID(Reserved.] <br /> LO <br /> O y4lpx S �py,TyP-[^13,ry��R,�.,NTA'L SERVICES � _ � D Transporter's Phone (9116) '371-5747 <br /> O RAMS i.7r1�E Y 1.11L/ 17Ss1F i.ti JJ SERVICES _ <br /> 00 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporters ID Reserved.] <br /> F. Transporters Phone <br /> Q <br /> Address 10. US EPA ID Number G. State Facility's ID <br /> WZ 3650 11. 26VH STRM.4. ER140NA f,.A 900-43 H. Facility's Phonein . <br /> o (323) 268 - 5b <br /> Q _ 12. Containers 13. Total 14. Unit <br /> < 11. gqUSy/D��rOTTfD�'e//ss�cyriip��tion(inc��lludippny�g,,PPrwrYjo��ptter ShippingName,HHapzarr^diClass,and ID Number) No. Type Quantity Wt/Vol 1. Waste Numberry <br /> �= L'�VI.Y�"RC Rt'E AC,.rAE.t.W' US WASTE�SaiJi.ID �} State .J ay '. <br /> 3 G (oily solids) ERG P #171 � � a� � 4! EPA/Other /&A <br /> E / ! <br /> mN Y ffit}�? / 'P "cl stat <br /> 00 E z * fry ff E <br /> V- RCN <br /> e� 7`�sT� ?T�+. C S� y �5� v 15 C, t 7 p s <br /> OO T d:.ul�t�ll.Bti.D)US WAS1 to SOLID, i'3 sF.'r•.^t, a s 9, EYA30 i7 p 111. State 352 <br /> a^ R ERG 400 417.1, EPA/Other � JfYNS� <br /> w d. <br /> $tate +��V <br /> t— <br /> LU EPA/Other <br /> U <br /> N <br /> J. A ditiana Descri ti ns f,��u••M ter'als{, ted Above K. Handling Codes for Wastes Listed Above <br /> 6. <br /> V) 11b. fWrOwpprLU <br /> a <br /> Z 15. Special Handling Instructions and Additional Information <br /> H"DURS TO BE TRAINU AND USE PPE. <br /> Z 241IR FMRGENCY CONTACT: 916-371-5747 <br /> LU <br /> 31 14. PACIFIC AVEANUE, ILODI, CA 952402 0,:Pe/.,PA0 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> .2 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 determined to be economically <br /> 0- practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> V) and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> ae available to `me and that I can afford. <br /> OPrinte 1pe! IIJi t _ J I ,t�•� Sigjr.re r f a Da Year <br /> 11 j[ L 14 tif»1+r/�I tvJ�-' 1 p �i.. f 3 (,�i , <br /> w T 17. Transporter 1 Acknowled ement of Receipt of Materials <br /> It Mo Day YearUW A . <br /> Printepej.Name Signaturg..... r•� j] <br /> w 5 �ir-"» C.M a �r3 <br /> LL- 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 RPrinted/Typed.Name signature Month Day Year <br /> T <br /> w E <br /> V) R <br /> Q <br /> C1 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> L <br /> 1 20. Facility Owner or Operator Certification of recei t"of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> i^' <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />