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Store of Califamn Envimmm mal Pmrh cvn n Agency <br /> Form Approved OMB No.4050-0030(EzP,res 9-30.94) See Instructions on back of Je 6. oepartm,m of Task Substances Central <br /> Please print or ype, form designed for use en elite(12pnch)Iy ricer. - V 5acrmnenm.Califoma <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in rhe shaded areas <br /> UNIFORM HAZARDOUS is rat required by Federal law. <br /> WASTE MANIFEST C1 Al Ll 01 01 9171 11 91 1 4 51 5 01 A iaf 1 <br /> 3. Generator's Name and Mailing Address DEN r S AUTO REPA I R A.Sets A,assf(est Document Number <br /> 308 S. ELDORADO ST, BLDG A 9355768 2 <br /> n STOCKTON, CA 95203 B:.Seals Ge ncout s ID <br /> 4. Generator's Phone ( (209) 462-1262 r.. <br /> m <br /> O' S. Transporter 1 Company Name 6. US EPA ID Number C Sete Trarepone/s ID, <br /> O <br /> C9 D. Traraponels fshane <br /> 5 rl Al Al Oil Al Oil 8141 fill 41 —7449 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. Shale Tramponer's ID <br /> U F- Trvaporte/s Phase <br /> V Q 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Sbe Facility's ID <br /> X)0c STATEWIDE ENV I RONMENTAL <br /> .00 12618 MAIN STREET HToci Phone <br /> a LOS ANGELES CA 90081 ICIAIDIOIOIOIOIS18 2151 <br /> j)U 12. Containers 13. Total 14. Und <br /> 0 Z 11. US DOT Description(including Proper Shipping Name,Hazard Coss,and ID Number) No. I T,7. Quantity Wt/Vol I. Wase Number <br /> �� Sine <br /> RG, WASTE GASOLINE, 3, UN1203e II (DO18, D001) <br /> T3 G 0 4 D M 20 P ",erD018 <br /> cci E <br /> m N Is. Slate <br /> m E <br /> N R EPA/Other <br /> e A <br /> o T c. Slate <br /> m O <br /> R EPA/Other <br /> K <br /> W <br /> Z d. Slee <br /> Z <br /> LU <br /> U EPA/Other:;: <br /> W 1 " <br /> N <br /> Z .J Adddsonaf Descriptions for Molersdk ISle11"Abover2;. K. HandlingCodels <br /> for Wmtm Listed Above <br /> O "t1A 'UNL'EADED-GASOL?f WIHw.E ',`� """, .°; '.EAG I <br /> tail -( - ,?Z .�s. :;• �s. .m.rr'S'." 7 Mie a. // `6 .: <br /> l a'. -. <br /> Q 15 Special Ha dl ng 1 strocliom and Additional Informafiom24 HOUR EMERGENCY RESPONSE NUMBER 1 (800) 399-4357 <br /> Z 11A. PROFILE #a5!5,pQ R <br /> W <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the convents of this consignment are fully and accurately described above by ,.per shipping name and are classified, <br /> Qpacked,marked,and labeled,and am in all respects in proper condition for transport by highway according ta applicable intemational and national government regulations. <br /> U <br /> If 1 am a large quamity generator, I cenify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> ecarwmically 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 /> o. threat to human health and the environment;OR, 0 1 am a small quantiys�ms ,}�h el a%&d r ere generation and select the ben <br /> N wase management method that is available to me and that I can afford.l/l1 n �`� ^"•" �Cr~ n y <br /> Printed T Name Si <br /> Q / YPed gnaNre Momh Day Year <br /> � I <br /> Z17.-Trans over 1 Ack Pt of Materials <br /> W A Printtd/Typed Name Signaer <br /> Month Day Year <br /> z i1 C <br /> - W e <br /> 0 IS. Tromporner 2 Acknowledarommer of f Materials <br /> W T Premad/Typed Name Signature Month Day Year <br /> W F <br /> O R <br /> W 19. Discrepancy Indication Space <br /> so <br /> Q F <br /> U A <br /> Z C <br /> k <br /> l 20. Facility Owner or armor Certification of..for of hazardous maedala covered by this momf nt..at as noted in Item 19. <br /> T Printed/Typed Name Signmum Month Day Year <br /> Y �� c <br /> DO NO RITE BELOW THIS UNE. <br /> White: TSDF SENDS THIS COPY TO DTSC Y+"�:" _- .,•5. <br /> DTSC 8022A (9/93) To: P.O. Box 3000. Sacramento, CA <br /> EPA 8700-22 <br />