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State o1 C000-Its--En WoevIn al Protection Agency <br /> Form Approved OMB No.2030-0039(Expires 9.30-94) See Instructions on be f <br /> . page 6. <br /> Department of Toxic Substances Co.,Peae Rein or type. Form designed for use an elin,(1�/)typewriter. eeeh <br /> Sacramento,California <br /> UNIFORM HAZARDOUS 1, Generator's US EPA ID No. Manifest Document No. 2. Page 1 Inlormatian n the shaded aM05 <br /> WASTE MANIFEST o7d �o snot required by federal law. <br /> Ula 3 1 9 5 2 of 1 <br /> 3. Ge eratoes Name and Mailing Address <br /> RICHARD GIAMBRUNO FF <br /> 4E , <br /> 1301 Argonne Dr. , Stockton, CA 95203 <br /> In .. Generator'IPhone (209) 464-0201 <br /> 00 <br /> S. Transporter I [a <br /> spa mpany Name d. US FPA ID Number _ <br /> go NOR CAL OIL ICIAID191812141 7255 <br /> 7. Transporter 2 Company Name B. US EPA ID Number <br /> U <br /> U <br /> Nle 9. Designated Facility Nam and Site Address 0 US <br /> Ing nrTr.Mr T96664�1P[ <br /> O HVVY 33 <br /> s s7U <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12, CcMainen 13. Total 14. Unit <br /> Z No. T Oumhy %"/V i <br /> ''T%3 NON-RCRA HAZARDOUS WASTE LIQUID <br /> G (WATER & N OIL) 01011 T <br /> s ET G ovate <br /> m N b. <br /> as E <br /> r R <br /> Y A _ <br /> S T <br /> 00 O <br /> � R <br /> W <br /> Z <br /> U :.. <br /> W <br /> Z <br /> �g� r <br /> ° <br /> W Td E y: <br /> Q t � Y 1 yt V 5 <br /> QIS. Spacial Handling Instructions and Additional Information A/�yr� /.�, /1�,, /'1/ C sem' �u v���N�l!-y' <br /> ' APPROPRIATE PROTECTIVE CLOTHING /1 „ r /J l> q FN <br /> Z "EMERGENCY CONTACT" (209) 667-6692" q5304P.40 iA)O o� GO !"CIAL, <br /> SEE E.R.G. PAGE 31 CAO '7W663/77 BRXE 5 � z39 $ <br /> J16. GENERATOR'S CERTIFICATION: I hereby declare shat the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> J PPng <br /> Q pocked,marked,and labeled,and are in all respects in proper condition for transport by highway according ro applicable International and national government regulations, <br /> U <br /> If 1 am a large quantity generator, I certify that 1 have n program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> J economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> Nthreat to human health and the environment;OR, if I om a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. <br /> 0 Printed/Typed Nome Richard Thorpe agent for signature Month Day pYear <br /> URirharfi U ( 0 6 / <br /> Z 7 17. Transporter I Acknowled ement of Recei of Materials <br /> N Printed/Typed Name <br /> Signature <br /> K , d le / arii <br /> I <br /> W J <br /> - � 0 1R. Tran Mr 2 Ackrmwled ement of Receipt of Materials <br /> W i Printed/Typed Name Nre Month Day Year <br /> Oe i <br /> W 19. Dkcrepanecisti+tcalion Sp �• <br /> /rrfr <� � �` ;iXop C Jeno <br /> _ I <br /> l <br /> I20. F hl' Owrwr or eralor Certification of receipt of hazardous materials cover b this manifest exn 1 as noted M Ilam 1 <br /> Print9 <br /> T is typed Nome Sigres r Monh Day Yeor <br /> Y �� `el <br /> �I <br /> DO NOT WRITE BELOW THIS LINE. <br /> Whit.; TSOF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A (9/93) Tc P.O. Sox 3000, Sacramento, CA 93817 <br /> EPA 8700-22 <br /> •e <br />