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Oct 28 03 11: 46a Preferred Customer 205-G68-3880 p• P <br /> r y;' Slula o{California•-Epeiranmantal Proledign Agency See Instructions on back ag P�• r muni of Torr Suhstancas Control <br /> Farm Aoarw•ed OMB No.2050-6038[Expires 4.30-9 a Suuumenb,�:alifornio <br /> R Ylaysa} Form�.s`igngttta!vee ON elite(12-pikA)lypewrirer, — <br /> 1, Generators q5 SPA ID No. ManlFest Dxument No. 2. Pagel lnln mo ion III Ihn shOdad vreos <br /> UNIFORM HAZARDOUS is n t nquved 1jy Fadoral iaw <br /> WASTE,AANIFES7 f'��; f" M. •� = 'r' <br /> 3, C}eneransr•s NNlse and Mailing AddressA.f 1 I r Slak;Manifest Document Num r J-2700843 aw <br /> Pl 1 4 UC% { ' B. slate;.e"stator s FD <br /> s7 1. Gen+mloh Phone 1. 1,• I I I A _ I <br /> R <br /> c4 5. Sransparler I COmpeny Nome 6. U9 EPA 1Q-Numb+r G_ SMh,Trnnspornr's ID[N [ <br /> kn� t� '] c1 <br /> o fISYSLf�ii.rl t+f�IALLr Y v11L1�i7L OIL y A L 4 V V D. Tronspartars4hone �u(j- lite r ;. <br /> Cn.oa, <br /> 7. lmnsyi+rtAr 2 Compony NORIA B,'US EPA 10 Number E. Slats Tronsporter's IDI +rva j <br /> • F. Tr"wrlar's Phone <br /> r <br /> CO l4j <br /> 140, US CPA 19 Number G. 3101;N too O .o.. <br /> Z *,',101)CLAUS [LOAM N. Pnci1; s Phone <br /> ce <br /> 0 RIVEHIIANK, CAr3.*367 �AILIpI��O �i 1910 <br /> . <br /> 12. Containers i3. Tarok' 1 sill <br /> 11. US DOT Description(including Proper Shipping Nome,Hoard Class,and ID Muni NO. Y (Zuantity M t/V)l I. Waste Nusobe, <br /> za. NON-RCRA HAZARDOUS WASTE UQUI0 state 2, <br /> OILY WATER) ip (? i 7 TC: fPA/Other -- <br /> of E b, Stole <br /> v N <br /> CID E CPA/Other <br /> v A -- Slate <br /> C. <br /> 7 <br /> a) 0 FPA/Other <br /> ac Stat* <br /> U.1 d. <br /> ,Z EYA/allwr <br /> 'n <br /> J. Additlgrtol l:fescripllons for Malse;Q15 UaW Abgw .. K:i Nolclling Codes for Wastes lis llsovn <br /> J <br /> QIi.Y�Aii1Tr� <. a ;'I 6 <br /> z <br /> 15, Sp+riol Hemfiling loorudions and Additi9slo1 Information <br /> 0 <br /> C�lt7i/i:`7 r <br /> Z F_ME:RC`r,NCY I?MONO 209-+((7.9857 <br /> s <br /> a 16, GENERATORS CERTIFICATION; I hereby declare that 1he<ORI I of this mnsignmem am fully and occuralely described abo' by proper shipping nam one ole r:lvs a;v,l,w*<k-d. <br /> marked,and labeled,and ore in oil rrMpeds in proper conditien for transport by highway xcording to upplicable internotk-tal and nalianul gOvnrnm nr+;gufarians. <br /> IF I em a 14rge+fuantiry generator,I crrllfy toot t have a proprani In place 10 reduce ills volume and ivxic4y of%vosso geanrarad to the degree 1 hu• qio ermined to be econamEcally S <br /> 0. proctioa6le and IhoF[hha�e aeleded rh+ tact co6le melliod OF treatment,stargge,or dispasal'cuneetly gwilo6lA to me whi,"h minimizes the present a d f au re Ihrswl lu hums;"health <br /> VJ p Anrrs,lian and whl l the hest w uta management rnefhad shut Is <br /> and the egv,ronment;OR,if I am a small quantity genrroter,I bare made o good faint effort to minimize my waste ff <br /> oc available to me and that I s:an afford. <br /> Q -- Moarh parr-- 7nnr— I <br /> Primed/lyped Noose Vn f { <br /> 17_ ham nor 1 Acknowled ernmi of ileee" r of Mareriob J ... <br /> lD f � Mnnth pay 7nar <br /> OS PrinasdlTypad Name Siggplure <br /> tl 18'. Trans rtef 7.AcknowlAd,em+nt A f of MOterials ��_ ----•• <br /> Q 1 ' Sglsatum Murch Ony <br /> Printed/Typed Name Year <br /> ssu C I I <br /> U 19, Discrepancy Indication Spoet <br /> F <br /> z A } <br /> f <br /> f 20. Feeili Owner Or O rator Carrificativn of wei ous Oi hazardmateriels ce•ered F m this manifest axes noled in Item 19. <br /> T Prinjed/Typed Name Signelure Ur.y Year , <br /> Y <br /> '00 NOT WRIT,EBE,LOW THIS LINE. <br /> DTSC 8022A(1/99) silt•: 'ILA:I'.,l'A:111' 1.1 t <br /> EPA 8706•-22 <br />