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Sror of Cdifornfl"eviromna4d Protection Agency <br /> Form Approved QNB Ne.2030-0039(Expires 9-30-94) e� Sao Instructions on back ...saga 6. D.portmeM of Ta.k Substances Control <br /> Please prize ar lype. Form designed for use m slit(12pikh)typewriter. Sac.wneMo,California <br /> UNIFORM HAZARDOUS 1. Generalor'.US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br /> WASTE MANIFEST CIAIC10101 110121214111618 is not required by Federal law.1 0 7 9 of 1 _ <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Num _ <br /> $ VALLEY WHOLESALE DRUG CO. , INC. q2 S v 1 9 7 9 ,r <br /> P. 0. Box 2065, Stockton, CA 95201 B. State Generator's ID <br /> 4. Generator's P6asr (209 466-0131 <br /> S. Transporter 1 Company Name 6. US EPA ID Number C. Slate Transporter's ID G <br /> m D. Transporler's Phone 0 <br /> NOR CAL OIL CAD 9 8 2 4 1 7 2 5 5 209) 667-6692 <br /> 7, Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> U <br /> F. Transporter's Phone <br /> K 9. Designated Facility Naar and Site Address 10. US EPA ID Number 'State Facility's ID <br /> REFINERIES SERVICE 'I C1 Al DI 01 Al 311161617121 Al <br /> n o 13331 N o Hwy 33 W. Farihly't Phone <br /> a-iPatterson. CA 95363 ICIAIDIO1813111616171218Ann 874-4444 Innn <br /> 11. US DOT Description(including Proper ShippingName,Hazard Class,and ID Number No Containers 13. Total 14. Wdt <br /> 00Z P ( pO ) No. T OuanT Wt/Vol I. Waste Number <br /> N3 a'NON-RCRA HAZARDOUS WASTE LIQUID ;'at <br /> G (WATER & OIL) 01 01 1 <br /> �+ E <br /> to N b. State <br /> gyp E <br /> st R EPA/Other <br /> 68y T C. state i <br /> O <br /> K <br /> R EPA/Other <br /> F <br /> Z d. stat <br /> W <br /> U <br /> EPA/Other <br /> W <br /> O 'for Materials Listed Above *{ K. Handling Codes for Wastes Listedd A Above <br /> N TANK BOTTOM WASTE b. <br /> RINSATE <br /> C. d. <br /> Q13 Special Handling metre t ons and Additional hformalin n <br /> i APPROPRIATE PROTECTIVE CLOTHING <br /> W "EMERGENCY CONTACT: (209) 667-6692" <br /> E.R.G.SEE PAGE <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contends of the cansigmnent are fully and accurately described above by proper shipping name and are classified, <br /> Q packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U <br /> � 11 I am o large quantity gmeratoq I certify that I haw a program in place to reduce the velums and toxicity of waste generated to the degree I have determined to be <br /> -z economically 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 /> tl threat to human heahh and the environment;OR,R 1 am a small quantity generator, I haw made a good faith effort to minimize my waste generation and select the best <br /> N <br /> K waste management method that is available t me and that 1 can afford. <br /> Q Printed/Typed Name Martin Thorpe agent for Sigmaum 1 Ma Day ear <br /> Valle Wholesale Dru Co. Inc. <br /> Z T 17. Tmemporter 1 Acknowhulgernernt of Receipt of Materrk <br /> � ♦ Printd/Ty me .- Signature /y r Mote Day Year <br /> F o 18. Tr iter 2 Acknowled moot off R«e' of Matedak <br /> LLl Pdntd/Typed Name Sigrrahme Month Day Ysw <br /> O <br /> WW 19. Discrepancy Indication Space <br /> UF <br /> A <br /> z I <br /> _ 1 <br /> L <br /> I 20. Facility Owner or Onomfor Codification of receipt 0l hazardous materials cowed by this manifest except as noted in Ilam 19. <br /> T Printed/Typed Nome Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 0022A (7/92) <br /> EPA 8700-22 L.ihr a .I rIF"AL n: ki tC.II IS �- <br />