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eRUG-29-91 FRI 6: 10 SAC Ar.. FAX N0, 9165vl�284 P, 03 <br /> Stale of Californfi—Health and Welfare Agency ` See InstXclToria on Back age 6 Department of"satin bananas <br /> '.Form,Aqy roved OMB No.2050-0039(Expires 9-3091) '"i'"if" a0d Front of PagttY' { Toxic Substances Control Division <br /> 'Pbail{p)Inl or type. Form designed Ia use on slid(Y2-pitch typewriter). California. r <br /> UNIFORM HAZARDOUS 1 1. Generator's US EPA 10 No. Manifest 2. Page I Information In the shaded areas <br /> Document No. <br /> WASTE MANIFEST <br /> of is not required by Fadard few. <br /> 3. Oaneralor's Name and Mailing Address A. State Alanflest.Document Number <br /> Fr A. A. AIRNAYS FAOILIlIBB SECTOS ' t <br /> 9424 Kiefer Boulevard, Sacramento, CA. 96827 e. stat.Genarato as . <br /> f <br /> a. Generator's Phone 91111 ) 07111-41"119.0 <br /> n 6. Transporter I Company Name 6. US EPA 10 Number Q. State Tnnaport•r'a <br /> n <br /> D.�Tran "? <br /> ssPlane <br /> Vx4ce Coop- 11 16 <br /> hrtar 2 Company Name <br /> B. US EPA ID Number E;,AT!.� ;,9Iate,TnnapgRer■ID <br /> 3 <br /> F. Treneporfe('e.Phau .'' <br /> m 9. Designated Facility Name and Sita Address 10. US EPA ID Number 0:,State Facility's m <br /> x <br /> I <br /> H It H Snip Service Coapany Ii all I y Ph �. <br /> 0 220 china Basin Street <br /> Alan FrAnniald7ifli A 0,11117 101611 <br /> 4Z IC IA In 10 10 14 12 Coolsiner 1-6. rore'r <br /> 11. US DOT Description(Including Proper Shipping Name,Hazard Class.and ID Number) dly Unit I Waste No. <br /> ,u OvanNo. Type Wt/Vol <br /> B <br /> L) <br /> ud 612 <br /> s. <br /> �€ ° RESIDUR DIESBL TANK EPA/other. <br /> e <br /> — <br /> 3 NE b. State <br /> 1$ A EPAIOIW <br /> W T ie <br /> v R C. State w�;r I a <br /> FPA Ogter,r <br /> Said •�+ <br /> w EPAlc)tiTar, <br /> U <br /> J Additional Descriptions for Materlau Listed Above - K. Handling Codes rot Wastp LUled Above, r .�, r <br /> N EMPTY 1,000 'Yallon teak last cout6ging iile,sttlt 01 &t y <br /> it 'tank inerted;�►ith dry lco for transport. :,,;.A e q~ t <br /> 0 PROVII-11 0111147 <br /> — 15. Special Handling Instructions and Additional Information <br /> = JOB 080.112 . JOB SITE: 'ATCI 'STOCKTON, (S <br /> CK) <br /> € 24 Hr. Emergency Contacts H A H ;(418) 543-4835 Stockton Airport <br /> J <br /> J <br /> U 8. <br /> � GENERATOR'S CERTIFICATION: I hereby declare that Ib contents of tole per condition <br /> are fully and acct by higelyhway <br /> y ac accobadrding <br /> gto a by proper ternang name <br /> J and are classified,packed,marked,and labeled.and are In a6 respects m proper cnnQilion for transport by hiphwry aocordinp to applicable international and <br /> a national government regulations, , <br /> to <br /> If I nm a lugs quantity generator,I certify that 1 have a program In place Io reduce The volume and toxidly of waste generated to the degree I have detemnlnsd" <br /> ¢O to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently aveaahle to me which minimizes the <br /> present and future threat to human health and the environment:OR,If 1 em•ams 11 qu lily generator,1 have made a good faith effort to minimize my weal* <br /> > panenllgn and educt Me best walla management method that is available to ma a tit I can afford, <br /> 'O .s Mordh' Day . Year - <br /> w Primed/Typed Nema /+ Sig^ <br /> W W I 1G - <br /> T 1T. Tnnsporler 1 Acknowledgement of Receipt of Materials <br /> W Mnarh Day Year <br /> .`. Q A Printed/Typed Name S1 cera.. <br /> o S JAAFS R. M <br /> W O 1a. Trenspodar 2 Acknowledgement of Receipt of Matedrda 1 / <br /> ` R PrMled/T;yped Name <br /> nature MnnfA Day . .Year - <br /> U T <br /> E <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> L .. <br /> I 20. Fadllly O mer or Operator Ce tion of receipt of hazardous materials covnr•tl by this manifest exeeu; s nu—m nam t 9. <br /> TPrIN•ii�d • Signature Monts OnY Yui <br /> V <br /> DHS 5022 A of Write Below Th <br /> EPA 9700-22 <br />