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pw <br />Slane L _ro omOMB No. nmen:m .. ,r.ruun wyency <br />Form 4pproroa D.wE No. 3050-J079 Eaoirn 976961 �,/ See Instructions on bark `efioge 6. o,panmem al m.K sabaanc.+cannel <br />Please stmt ar mea. Form deuanvd lo• usv an vfih, 112o1rcht mavwnMr. Sacramasc, Cold.nsm <br />DTSC 8022A (1/95) <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS UNE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 70 DAYS. <br />To: P.O. Bos 3000, Sacramento, CA 93812 <br />1. Ganeroci s US EPA ID No. <br />Manifest Document No. <br />2. Pope I I <br />Informafian in the shaded am& <br />UNIFORM HAZARDOUS <br />is not required by Federal low. <br />WASTE MANIFEST <br />of <br />3. Generator's Name and Mailing Address <br />A. Shah, M'"f' D°""""' N mlaw 9 5590526 <br />NAVARRA BRCS. <br />475 W. BLEWETT ROAD, TRACY. CA 95376 <br />& Shah, GeMnswes lD <br />A. GeM1at01 S Ph." <br />S. Transporter 1 Company Name 6. US EPA ID Number <br />c. Shah, rmeapartels ID <br />7 <br />D. Transporter', Pisash, <br />WXW D C <br />t l <br />' <br />v <br />7. Transpomr 2 Company Nome 8. U$ EPA ID Number <br />E. SIaN TronaporNla ID <br />1 <br />R. Tramrwnr'F Plmne Ai'--:.. .. <br />9. Designated Facility Name and Sift Address 12 US EPA ID Number <br />G Seale rod s.ID <br />H & H SHIP SERVICE COMPANY <br />rd Atm: <br />220 TERRY FRANCOIS/CHINA BASIN <br />W FadW/s Pias. +i <br />I <br />" (415•) 543-4835 x <br />11. US DOT Description (including Proper Shipping Name, Hazard Clan. and ID Number) <br />12. Comainen <br />13. Taal <br />Quo" <br />14. Unna <br />Wt/Vol <br />L Wada Mmsber°'Y�� <br />No. <br />Type <br />3°°512 <br />RESIDUE OIL STORAGE TANK <br />EPA/Oder <br />G <br />NON-RCRA HAZARDOUS WASTE SOLID <br />01 01 1 <br />T P <br />010,515, 0 <br />P <br />E <br />N <br />E <br />b. <br />RESIDUE HYDRAULIC HOIST <br />Stam51 2 ; =r <br />_ <br />EPA/Off-,. <br />R <br />NON-RCRA HAZARDOUS WASTE SOLID <br />01 01 1 <br />T P <br />010,510, 0 <br />p <br />A <br />T. .,,.,r <br />T <br />c. <br />State <br />O <br />EPA/Odw <br />R <br />i <br />I <br />d. <br />ShA' i'q •. )tih SY <br />EPA/WM!+c <br />I <br />L AddR sinal DwriptioM far Maftr" Us ed Above <br />'HYDRAULIC <br />` <br />K. N fa Waaea <br />M., Handling <br />lined Above, <br />b Te <br />EMPTY 550 GALLON STEEEE TgNK"AND EMPTY <br />TANK INERTD WITH <br />01 <br />`' <br />HOIST. WAS DRY ICE &HOIST <br />ylAS <br />PLUGGED/WRAPPED DRY ICE FOR SAFE TRANSPORT. <br />d• <br />PROFILE #A6056 <br />�. <br />IS. Special Handling Instructions and Additional Information <br />JOB#16563 <br />JOB SITE: <br />24 Hr. Emergency Contact: H&H #(415) 543-4835 <br />151 EAST 11TH STREET <br />WEAR APPROPRIATE PROTECTIVE CLOTHING <br />TRAY- CALIFORN <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the content, of this consignment are fully and accurately deecribed abow by proper shipping name and am clanified, <br />pockd, marked, and labeled, and aro in all respects in proper condition for transport by highway according to applicable imemational and national gowmment regulafians. <br />H I am a large qua" generator, I certify that I some a program in place ft reduce the volume and toxicity of wash generated to she degree I haw determined to be <br />economically practicable and that I haw selected the practicable method of nvonment, <br />+crape, or disposal currently a milabM so me which mmimixes the pmrrd and futon <br />Mreat to human health and she eneiromsent, OR, if I am a small quantity generator, I <br />how mode a good faith effort to minimize my wash, generation and select the best <br />wash, mono emeM method Mm is awilable c me and that I can afford. <br />Primed/TypedNTh�a �j <br />SignaNn <br />Month Day Year <br />T17. <br />Trans r I Acknowled mem a Recai of Materials <br />A <br />Primed/Typed Name <br />SignaNI <br />Menne Day Year <br />= <br />r <br />JIMMIE H. REESE <br />0 2 1 5 9 6 <br />Acknowled ement of Receipt of Moteriah <br />( <br />Printed/Typed Nome <br />ra <br />Month Day Year <br />E <br />19. DiscnpaMy Indication Spoce <br />F <br />A <br />L <br />I <br />L <br />I <br />20. Facility C4rter or Oporanu Certification of receipt of hazardous materials covered by this manifM ..c*w as noted in Mem 19. <br />T <br />Printed Tped Signoton <br />Ake Dryr ea <br />/ <br />O 1 Z 1147 9Y (01 <br />DTSC 8022A (1/95) <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS UNE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 70 DAYS. <br />To: P.O. Bos 3000, Sacramento, CA 93812 <br />