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Stam of California—Eswironmenml Protection Agency <br /> Form Approved OMB No.2050-0039(Expire,9-30.99) `` ww See Instructions On back Of pr b. Department of Toxic Sebstances Control <br /> Please print or type. F°^^designed for use on dile(12-pifthf ype.�i. vele Socramanm,California <br /> UNIFORM NAZARDOUS 1' C1°nerator's US EPA ID No. Manifest Document No. 2 Page I Information in the sh.dd areas <br /> WASTE MANIFEST is of regoired by Federal law. <br /> 3. Generator's Name and Moiling iddross OLytel p.Ari SCrdrG— S*A, Q/) A. Sloe Manifest Document Number <br /> .10 J14K nNd Ckit r ,5 MAV RO <br /> B. State Generator's ID <br /> 4`1 <br /> A. Generobfs Phone 1 r/q <br /> C4 5. Tronsparter 1 Company Name -. 6. US EPA ID Number C. Stere Transporters ID <br /> h <br /> W <br /> o ASBURY ENVIRONMENTAL SERVICES D. Transporrer'sPhone 13101886-34e* <br /> m 7. Transporter 2 Company po po y Name 8. US EPA ID Number E. Stora Tronsporter's ID <br /> 's F. Transporters Phone <br /> Q <br /> V 9. Designated Facility Name and Sim Address 10. US EPA ID Number G. State Facility's ID <br /> DEM <br /> `a ENNO KERDOON <br /> 1 _oZc M a1 Lwx 00, OPTOK CA MR H. facility',Phone <br /> NO p (318)337-7108 <br /> W U 11. US DOT Description(including Pr Shipping Name,Hazard Class,and ID Number 12. Comolners 11 <br /> . Tw.i 14. Unit <br /> p ( g aper ppm8 1 No. type Quantity Ws/Vol L Waste Number <br /> LQ NON-RCRA HAZARDOUS HASTE, LIQUID 5fa" 2-. <br /> 003 G (WATER,OIL) No Placard Required EPA/Other <br /> �o NOile <br /> N b. TT sate <br /> m E <br /> R EPA/Other <br /> a A c. Stole <br /> o T <br /> ado O <br /> _ R EPA/Other <br /> z <br /> w d. State <br /> Z <br /> Z <br /> w <br /> U EPA/Other <br /> asme._Gsfed Above , <br /> rn <br /> W <br /> K <br /> O15. Special Handling Instructions and Additional information 001533 <br /> H <br /> Q 4LOVE3 [ We7®L69 @7ERC3SEI2"Y CON'_^AGT:FSEL fU.RPBR (324)387-3100 <br /> Z <br /> W_ <br /> F <br /> 16. GENERATOR'S CERTIFICATION: Ihereby declare that the contents OF this consignment aro fully and accurate)y d...rild above by proper shipping name and are classified,pocked, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according m applicable international and notion. government regulations. <br /> s l.J <br /> J IF I oto a largequantity generator,I certify that have a program in place to reduce the volume and toxicity of wasm generated m the degree I have determined to be economicallyY <br />• a practicable and that I have selected the practicable method al treatment,storage,or disposal currently available to me which minimizes the present and future threat m 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 bast waste management method that is <br /> 0 available to me and that I can afford. <br /> >. Printed/Typed Ngne •'l Signator. -, Month Day Year <br /> Z <br /> �/ Z Lr <br /> 1 <br /> T 17. Trans rter I Acknowled .meat of Receipt of Materials <br /> MW j Printed/Typed Name Signature I) ( month Day Year <br /> W F � r ^" <br /> W R I8. Trans rmr 2 Acknowled ement of Recei t of Ma rials <br /> 0 ER Printed/Typed Name Signap(e;' Month Day Year <br /> w <br /> ' Lis R <br /> V19. Discrepancy Indication Space - <br /> ? A <br /> C <br /> I <br /> L <br /> ( 20. Facility Owner or O rotor Certification of receipt of hazardous materials covered this manifest except as noted in Item 19. <br /> T I Prinmd/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A (4/971 <br /> j EPA$700-22 Yellow: GENERATOR RETAINS <br />