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State of California—Emironmentol Protection Agency �,—~-�—•— _ ---� <br /> Form Approved OMB No.2050-0039(Expires 9-30.99) See Instructions on back Ga a 6. - <br /> PI_ease Prinf ortype- Fgrm designed for ass on.tiff f 12-pills of writer. 9 Department of Toxic Substances Contra <br /> - Sacramento,California <br /> UNIFORM HAZARDOUS G°nerotor's US EPA ID No. Manifert Do mesa f No. 2. Page 7 nforma on cr he shaded wens <br /> WASTE MANIFEST t Y 7 ��� 5 jF, isnot rq.insdbyFederal law <br /> . <br /> �/ J 1' <br /> 3. Generator',Noma and Mailing Address 't O f fa^. _ A Slatr Manifest Document Number - <br /> 905"/V-E�ioWt, ,tl POO 20954678 <br /> Sfm•lnr. 44 9 Sdc�j B. sta.G.na ator's ID <br /> 4 Ganerotor's Phan. 4 9 0 737-tCr.�O <br /> "105: Transporter 1 Company Name 6. US EPA ID Number C. State Transport✓,ID.IReserved.) <br /> m <br /> 00 :r7 'tlCAi'i VALLEY ,sfAvT; OIL ; a n a 7 8. It D. Tramparbrs Phare-a00-732.4M <br /> 7. Transporter 2 Com n F <br /> Fa Pv Y Name 8. US EPA ID Numhar E State Transporters ID(Reserved.) <br /> Av F. Tmnsporbi s Ph.. <br /> "W ,Lgc�l p!Nams.pprf, t}Qr� r u. 1�� 10. US EPA ID Number G. $ta aclby'8y 1 1914 <br /> 15 L _ _ - <br /> LA Z 1700 S. SOTO ST <br /> .IIaQ neveJ - H. Faciliys.Phone <br /> Vi �A. ILa i Z 17 a,$ <br /> LL <br /> ��hal 11. U$DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Tato) 14. Un8 <br /> - No. T Quantity WI/Vol I. Waste Num .1 <br /> a. �-�L'GIA�AROOUS WASTE d 10"'Ut a ..... S� <br /> Z r' <br /> ! <br /> OILY WATER 1 T <br /> N E ! 0 0 •e T G EPA/other <br /> b. <br /> om E State t'.o <br /> Q R j EPA/Odor <br /> A vrr <br /> oT <. r State... __ <br /> m 0 <br /> R' 1 EPA/Otherd. <br /> W <br /> Z' -.t Additional Desmpfiam For Materials Listed Above - f a <br /> Z R.'H ndling.0 rWasha Usfed Abaw <br /> Q OILI WATER eb. 7 <br /> m <br /> .Z <br /> O 15. Special Handling Instructions and Additional Information <br /> Z GLOVES <br /> EMERGENCY PHONE 209467-W" <br /> w <br /> fc'C k T N'!(` r <br /> Q16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment...Fvlly',md accurate) described aboby proper ship ng name and are classified,packed, -� <br /> U marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> IFI am a la a uanti <br /> rg q generator,I certify that I.limns a proggram in place to reduce the wlunse and toxicity of waste generated to the degree I haw determined to be scammiavlly <br /> Hpracticable and thvt I have selected the practicable method of treatment,storage,w disposal currently available to me which minimizes the present and funire throat to human health.-:' <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my west. ration and select the best waste management method that i. e <br /> O awihable to me and that I can afford. <br /> } Printed/T Nacos / -----..�" ^� Signature /i Month Day Year <br /> Z &IQ /I � // <br /> w T <br /> R 17 Trons .ter 7 Acknawled jeffi of Receipt of Materials <br /> WePrinted/T Name noNra <br /> WS j month Day Year. <br /> P r /E6 <br /> O <br /> Transporter 2 Acknowled emanf of Racer ,of Mabnals - <br /> R Printed/T <br /> w E YPad Name SignaNre Month Day Year. <br /> 6 R <br /> U i9. DiscrepancyIndication Space <br /> Z F <br /> _ A <br /> G <br /> L <br /> I 1 20. Pocili Owner or Operator Certification of scar t of hazardous mabrials covered b this manifmtexce t m oared in Item 19. <br /> T Footed/Typed Name SignaNra Month Dar Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) <br /> EPA 8700-22 Yellow, GENERATOR RETAINS <br />