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Ston'of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back age 6. Department of Toxic S.bsronres Contra) <br /> Please print c-type. Form desiglsed for use on diro(12-pikh) .( sorr. I Sacramento,California <br /> --MrORM HAZARDOUS �Perobr's U$EPA ID No. _FS1a0IW12acyment No. 2. Page 1 Information inlhe shaded areas <br /> WASTE MANIFEST is not required by Federal I.. <br /> '1 14 16 1214 1 of <br /> 3. Generator's Name and Mailing Address a Manifest Document Numher 98111365 <br /> .v ^` �s ^ <br /> FAEJ +Ii: MAE FOUI:DATION A Y'rkl 1;r: 1<+:'c L <br /> W. <br /> /���I hC� 4V/ S8 \.J 6 <br /> h 7743 ;:LST LNIZ, STOCKTON, CA 95210 B: Slate Generomr s ID <br /> urt A. Csenararoh Phone( 209 1 237-2020 . <br /> hS. Transporter 1 Compony Name 6. US EPA ID Number C State Transportefs ID <br /> 8 NOR CAL OIL ; ID 19 IG 12 14 11 17 12 15 5 D. TlanSpartar 1 Phone <br /> 7. Transporter 2 Company Name 8. US EPA ID Number J X.'State Transporter's ID 2 <br /> 0 )667-61592 <br /> 'V $.Transportxes Phone <br /> ' 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> )z 14AYSIDE OIL Ile IX. <br /> -10 210 a CINAL ST. H. Facility's Phone <br /> In <br /> ;, ,x 408427-3773 <br /> i V 71. US DOT Description(including Proper Shipping Noma,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unrt <br /> No. T e Quantity Wt/Vol I. Waste Number <br /> Z a. <br /> Stale <br /> NC44-n."•iA iSAZARDOUS WA -TE LI;JJID223 <br /> 3 G EPA/Other <br /> E a m 4 <br /> mN b' State <br /> w E <br /> 4R EPA/Other <br /> ,sr <br /> A <br /> CT a state <br /> m O <br /> R EPA/Other - <br /> z <br /> Zd' State <br /> W <br /> U EPA/Other <br /> W <br /> H <br /> J. Additional Deuriptions for Materials listed Above ': <br /> ZO a Codes For Wastes Listed Above <br /> ' ..: 11 r x <br /> 10 <br /> w ,.• . r .:., T b. <br /> RINSATE n, . . <br /> a <br /> 0 15. Special Handling instructions and Additional Information <br /> AP ?RIAi ?F20TI TIVL CIMHIC.G SITE ADDRESS: <br /> Z "li141'MCY C;xJV,—T: (209)541-9145" <br /> 25433 EUIdIC'.-: sT. <br /> :iii: :ei2.G. 171 <br /> c <br /> 16. GENERATOR'S CERTIFICATION: I hrby declare that the contents of this Co-si nmentare full and accurate) described above ^ <br /> g Y by shipping name and aro clmsiFied,pocked, <br /> U marked,and labeled,and aro in.110.1.pects in proper condition For transport 6y highway according ro applicable international and national government regulations. <br /> ! IF I am a[.,go entity codify pro R P <br /> i g q...ti generator,I cern that 1 have aFram in lace to reduce the volume and tmsiciy of waste generated to the degree have determined ro ba economical)y <br /> sn practicable and that I ave selected the practicable method o treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> O and the environment;OR,if I am a smaquantity generator,I have made a good Faith effort ro minimize my waste generation and select the best waste management method that is <br /> available to me and d,at I can oFFord. <br /> UPrinted/Typed pa Signatore Month Day Year <br /> Z 1 ^/� �L- <br /> W T 17. Tran r Acknowled ement f irwei t of a as r1 <br /> R <br /> W X Printed/Typed Name SignaNre Month Day Your s <br /> '46— <br /> LL F 18. Trans iter 2 Ackn= emeat of Reaei t of Materials <br /> O T Printed/iyped Name Signature Monde Day Year <br /> y E <br /> Q R <br /> U F 19. Discrepancy Indication-Sp— <br /> A <br /> C <br /> I <br /> L <br /> 20. Facility Owner or Operator Certification of receipt of hazardous materials covered this manifest exceptas noted in Item 7 9. <br /> T Printed/Typed No,, Signature /�� Month Day Year <br /> Y 1214ZZ 4L <br /> / 7. <br /> DO NOT WRITE BELOW THIS LINE, <br /> DTSC 8022A 14/971 <br /> EPA 8700-22 Green: TRANSPORTER RETAINS <br />