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abhatColitomio—EnvironmentalProtection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-991 See Instructions o;b6ik 'of'pogs 6 Depannrnt ak Toxic S.",Carnal <br /> Yeose prim w type. Form deigned For u»en elite(I1-pitch(tyw -- ,{,. Sacramento,California <br /> UNIFORM HAZARDOUS 1. '('9r61oi'US EPA ID No. Manifest Document No, .� 2- Page 1 Informchon in the shaded areas <br /> . is nae required by Federal low. - <br /> WASTE MANIFEST 1 i 2 4 of 1 <br /> 5 3. Gener mess Name and Mailing Address <br /> UNLAN!> GASOLINE n <br /> 0 <br /> 085 E"r FREMDNT ST. . STOCK GA 95205 <br /> i <br /> A. Generator's Phone?09 1465--3676 n e r 4 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number <br /> m ,G= CAL O T L C AD 9 82 4 172 JJ <br /> z <br /> 0' i'.id51C s a•'YF iL� <br /> r� <br /> N Y rJ <br /> 7. Transporter 2 Company Nome B. US EPA ID Number n'• 4 ,J•^ <br /> a <br /> U1'ty Name and Site Address 10. US EPA ID Number <br /> fJL a r tL Ng. <br /> OIL CO. s <br /> 7 00 S. S+JTt� "ST. : <br /> v Y <br /> ,O rtc ANGELES. C:A. gri022 <br /> _ss. <br /> 12. Canines 13. Total ld. Unit <br /> j 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No Type Ovantiy W/`.leala <br /> tiff JONti-RCRA HAZAF'DOUS WASTE L. 101-17D <br /> 'WATER & St-uDGE i {,[ <br /> re.et N Is. St�ab'"` 2 <br /> mm' E <br /> a REPNOIhad:�--_x"•7,,.1,- <br /> i A ` <br /> T C. <br /> to O a4 <br /> R 'EP�✓od».la <br /> i d. <br /> s Addihond Dasc ham for Mabnals Listed q , C 1 , achUi«_Abovs ` 'r <br /> a <br /> ad <br /> `6 15. Special Handling Instructions and Additional Information;.,. - <br /> a PF'F'OPRIATE PROTECTIVE CLOTHING <br /> EMEPGENCY CON-I'ACT; i2-'V9)541-914'5'' <br /> EE E. R. G. 7.?1 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore Fully and accurately described above It proper ship ing name and are classified,pocked, <br /> Q marked,and labeled,and ore in all respects in proper condition For transport by highway according b applicable inhmational and nationorgovernment regulations. <br /> IFI am a large quantity generator,I certify that I hove a program in place to reduce the volume and toxicity of waste generated ro the degree I hove determined to be economically <br /> y practicable and that I have selected the raclicoble nothod of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human 6.IX <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 best waste management method that is <br /> - available to me and that I can afford. <br /> Printed(/Typed NameSi rioN n 113r <br /> 0 1 17. Transporter I Acknowledgement df Receipt of Materials <br /> A Printed/Typed Namu�r _. Signature - IAO-t4Da�, .Year <br /> t, <br /> 31 <br /> -0 7 S. Transporter 2 Acknowledgement of Recei t of Materials <br /> 0 <br /> EPrinted/Typed Noma <br /> T SignaNnMonth Day Yecr <br /> • E <br /> B <br /> ` 19. Discrepancy Indication Space - <br /> Z F <br /> A <br /> C <br /> E <br /> 1 20. Facility Owner dr Onstralor Certification of pSeiptaf hazardous materials covered 6 his manifest z a Dred i Item 19. <br /> Prinhd/Typsd Na <br /> Y Signature <br /> _ = dr7 L1 L)-boy_ Ye <br /> 1 <br /> DO NOT WRITE BELOW THIS LINE. <br /> TSC 8022A(A/97) <br /> PA 8700-22 Green: TRANSPORTER RETAINS <br />