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Stole of Ctaifornia—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-991 See IG$fTUCfIODS OA backPlease prin ov ,rype. Form designed for use on elite(12-pit\ o tunith r. X088 6• Department of Toxic Substances Control <br /> �i Sacramento,California <br /> UNIFORM HAZARDOUS 1. Ganeroror's US EPA ID No. ManifestDocument No. 2. Papa 1 reformation in t e ahodad a eas <br /> WASTE MANIFEST I` 8 6 V 5 7 5 5 5 5 is not required Iry Federal law' <br /> of 1 <br /> 3. Genamtoi s Name and Mailing Address A. $tale Manifest Document umber <br /> LA FINCA PARTNERSHIP#I 6 <br /> o P.O. BOX 1307, BRASS VALLEY, CA Sh9d5 B. sate G.n.ralan to <br /> d. Generabr's Phone( 530) M-8464 <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. Stale Transporter's ID Rese ed.) <br /> h <br /> w Po ' ry <br /> ( <br /> NOR ill VN.. 1. (f 1 D. Transporler's Phone <br /> A 7. Transporter 2 Company Name 8. US EPA ID Number E. 51a1e Trans porm,s ID(Reserved.) ' <br /> �Q F. Transporter s Phone <br /> A V n ili teams red Site Add rus G. State Facility's ID <br /> ��0�'AN, t��s.-.s 10. USE ID Number <br /> Z 2430 ALMOND DR. <br /> �alacH. Faciliy/s Phone <br /> ^V0 SILVER SPRINGS, NV 118429 r <br /> ./a 11. U$DOT Description(includingProper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 1d. Unit <br /> V P ppi g No. T Quantity Wt/Vol I. Wash Number <br /> uZ a NON RCRA 14AZARDOU13 WASTE LK.IIJID State 221 <br /> _ (OIL A WATER) <br /> 3 G EPA/Other <br /> E <br /> oN b" State <br /> ca E <br /> N R - EPA/Other <br /> v A <br /> 6 T o. Slate <br /> m O <br /> R EPA/Other <br /> oe <br /> Slate <br /> Z <br /> w <br /> V EPA/Other <br /> W <br /> Z 1. Additional Descriptions for Materials Listed Above I Handling Codes for Wastes Listed Above <br /> OIL & WATER b. <br /> C. d. <br /> Z <br /> Z 15. Special Handling Instructions and Additional Information <br /> APPROPRIATE PROTECTIVE CLO11 ZINC: SITE ADDRESS: <br /> Z "FB111FRGENI:Y ('01iii:T: (209)652-8900" 1611 S. AIRPORT WAY <br /> F SEE:: F.11I 171 STCICKTON, CA <br /> 16. GENERATOR'S CERTIFICATION: Ihereb declare that the contents of this co signment am fully and accurate) described abovebpropershi <br /> U marked,and labeled,and are in all res y Is inProper condition for transport b hi hwa according ro a I y naari o name and are tiossified,packed, <br /> Psc' Y highway B pp!totals international and nafiona government regulations. <br /> ! If I am a large quantity generator,I certify that I have a pro ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economica11 <br /> us practicable and that I have selected the practicable method of treatment,sror.g.,or disposal currently available to me which minLm.zes the present and future threat to human health <br /> 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 /> ci <br /> 0 available to me and that I can afford. <br /> } Prinh l/Typed Nome I $!greater° Month Day Year <br /> o L O C) <br /> W TR 17. Transporter 1 Acknowledgement of Receipt of Material <br /> w A Printed/Typed NameSignature Monts Day Year <br /> w S r p <br /> LL 14 <br /> 0 18. Tram her 2 Acknowled a rel of ecei t of Serials <br /> 0 R Printed/Typed Name Signature Month Day Year <br /> w [ <br /> Q R <br /> V 19. Discrepancy indication Space I <br /> Z A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Nama Signature Month Doy Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />