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• - Stole of Calihmia—Emincrmental.Productive Agency _- <br /> Farm Approved OMB Ne.2050-00391Eapira,9-30-991 See Instructions on back a T9B b. Depamnem of Toxic Substances Control <br /> Ile6»print or". Fon"designed for um on offer I I2.pikhl Se-rifer. 1-.00 Sacramento.Coliform. <br /> r UNIf.ORM HAZARDOUS 1. Gereirawr's US EPA ID No. Manifest Document Na. 2. page 1 nforma°an in the shdd areas <br /> - WASTE MANIFEST 0183 of 1 n^ot req rd by Fede al law <br /> 3. Generaro/s Name and Moiling Address OLMeIAN SERVICE STATION <br /> 850833011- <br /> 11TH i CffiuSMAN RD. <br /> A G(209)e482-7769 TRACT, CA. 95376 <br /> Phone <br /> I - <br /> av S. Transporter I Company Name b. US EPA ID Number <br /> 0 <br /> ASRURY ENVIRONMENTAL SERVICES 313886-34" <br /> m 7. 4am orrcr 2 Company Name S. US EPA ID Number E � q!,{_ <br /> ": ... <br /> U 9. Designated Facility Name and Site Address 10, US EPA ID Number 6w•Acer P sfJe ID 'i Zy�q ',:>i.. <br /> Q DEMENNO KERDOON <br /> C)y2w VM RTtMWTOR, CA %m N. Facility's Phone - <br /> Mo 1 1318)537-7108 <br /> MQ 12. Containers 13 Tw.i 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> �U No. I Type Quantity wr/Vol I. Wrote Number <br /> C)4s <br /> ° NON-RCRA HAZARDOUS WASTE, LIQUIDSt <br /> (WATER,OIL) No Placard Required 1 TT EPA/ k <br /> 003: G <br /> 0 � NONE <br /> State - <br /> m E z EPA/Other- <br /> aR <br /> "t slow <br /> o T <br /> m O <br /> R EPA/Odlor <br /> W d. Slate <br /> H <br /> Z <br /> V �ry' EPA/Oth <br /> y) _....e.. ,. .... .. 6 Above <br /> O <br /> 0 M V <br /> J <br /> Q -9,S" ..4. <br /> I5. SpecialHandlingInstructions and Additional Information - 001539 <br /> ZGLOVES i GOGGLES EMML43NCY COETACT:2M HAIRPEA <br /> W <br /> 7.� <br /> (310) 560-32.10T <br /> 0 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the cummnts of this conignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Umarked,and labeled,and are in all respech in proper condition For transport by highway«cording to applicable international and national government regulations. <br /> J If am a large q,-nl7 generaror,I certify that I hwe a program in place ro reduce the volume and toziciy of waste genarotd to the degree I have determined to be economic.]yy <br /> d procticable and that I have selected Ilse practicable method of trsalmant,srorogs,or disposal currently available ro ma which minimize the present and Future threat to human hZc ' <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 mmbod Ihot B <br /> °C available to in.and that I can afford- <br /> 0 <br /> > Prmled/Typed Name r— Si l Month Day Year <br /> "°"reis <br /> Z + r , <br /> W T '17'Transporter I Acknowled amen of Ricin t of Materials <br /> 1 Printed/Tma _ Signature' "— Month Day Year <br /> vs <br /> la_ a I8. irons rM 2 Acknowld imam of Recei t of Materials <br /> O 1 Primed/Typed Nam. SignaNro Month Day Year <br /> H E <br /> 1 <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> 20. Facility Owner or Operator Cemficanon of rscel t of hazardous marcriait--i,,d by this manifest eece t or notd in Item 19. <br /> Printed/Typed Nam. Signature Month 0 Y Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> '97f Yellowy GENERATOR RETAINS <br />