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State of Califon 1-10a Isateelson A <br />Form g•my <br />Approved OW No 2030-ao391E,Pime 9.30,94) ` Sea Instructions on baek�page 6. �, nitsem <br />Please prim Toxic Substances Com.ol <br />m type. Form d4s•'d b � an tide (17giKh( �P..^e«. Sacrenemo, Califemo <br />ro .1ifor ns <br />UNIFORM HAZARDOUS <br />Oersermar s US EPA ID No. Manifest D«ument No. 2. Page 1 Information m she shaded Dram <br />WASTE INANIFEST <br />is not required by Federal kw. <br />CAC 0 0 1 0 0 11 2 4 8 8 1 0 5 of t <br />�. Oes.rererI Monroe and MaA•'V Adds <br />tic. FAve d_Doctnnerd ee ^a.rc..-.ps" <br />in <br />JEFFERSON SCHOOL DISTRICT <br />"` 288a_V <br />7500 W. Linne Road, Tracy, CA 95376 <br />e. StateC<ne,ata,zsw <br />C4 <br />d oww."eo nmae (209) 836-3388 <br />S. Ttatnrperter I Cnmpory None 6. US EPA ID Number <br />F <br />C. State Trarnporte s ID Q� f <br />v <br />^ <br />NOR CAL OIL C A D i 9 8 2 4 1 7 25 5 <br />D. Tran pa ter'e Poo a 209 667-6692 <br />7. TransperM 2 Company Name 8. US EPA ID Number <br />E. Stare Tnrssportc/s ID <br />__. <br />F. Transporter's Phone •� <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. Stvte F«iliy's ID <br />�o <br />REFINERIES SERVICE <br />j CAD 0 1813111616171218'1 <br />0 < <br />13331 N. Hwy 33 <br />H. Facility', Phone <br />Patterson. CA 9SI63 IrIAInInIAI,:IIiIAIrI7I?Ig <br />800 874-4444 <br />V <br />('� <br />11. UB DOT Description (including Proper Shipping Name, Hazard Ca <br />Class, and ID Number) <br />12 Cont <br />ainers <br />13. Total <br />Id. Unit - -- -- <br />No. <br />T <br />Z <br />Quasnity <br />WI/V.1 I. Wrote Number <br />a' <br />Ni <br />NON-RCRA HAZARDOUS WASTE LIQUID <br />Star, 223 <br />p�3 <br />G <br />(WATER & OIL) <br />01011 <br />T T <br />G EPA/°"° <br />ci <br />E <br />&&&1219 <br />WN <br />b. <br />State <br />E <br />R <br />EPA/Odser <br />y <br />A <br />T <br />c.',,,. <br />state <br />O <br />R <br />EPA/Othm <br />K <br />W <br />Z <br />Z <br />d. <br />Stara <br />W <br />EPA/Other <br />N <br />Z <br />ditanal Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above i <br />ANK BOTTOM WASTE G b. <br />RINSATE <br />c. <br />Q <br />15 Special Handling Instructions and Additional Itdormaffon <br />a <br />APPROPRIATE PROTECTIVE KKIIHKCLOTHING <br />Z <br />"EMERGENCY CONTACT: (209) 667-6692" <br />= <br />SEE E.R.G. PAGE 31 <br />r <br />16. GENERATOR'S CERTIFICATION: I hereby dackrs that she contents of the consignment am fully and accurately described above by proper shipping name and are classified, <br />Q <br />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 />V <br />If I am a large quomity generator, I certify that I have a program in piece to reduce the volume and toxicity of waste generated to the degree I have determined to be <br />economically practicable and shot I have selected the practicable method of tnto mem, storage, or disposal currently available to me which minimizes she present and future <br />S <br />N <br />threat to human heohh and the environment; OR, if I am a small quanlily general haw ma e a good faith effort to minimize my waste generation and select the best <br />waste management method that is available to me and that I can afford. <br />o <br />Primed/Typed Na— Martin Thorpe agent for <br />Signchtrc <br />M°a Da Y`°' <br />> <br />v� <br />0 1 3 91 <br />V <br />T <br />17. Tran iter 1 Acknowledgement of Receipt of Materah <br />W <br />Vr <br />N <br />Printed/Typed Nome <br />Si rs <br />Momh Day Year <br />JOE PUETT <br />0 1 1 3 914 <br />f0 <br />18. Troraparrier 2 Acknowledgement of Receipt of Materials <br />W <br />i <br />Printed/Typed Name - <br />S' <br />Momh Day Year <br />O <br />0 <br />e <br />W <br />N <br />19. Discrepancy Indication Space <br />Q <br />V <br />F <br />A <br />Z <br />C <br />I <br />_ <br />t <br />I <br />20. FdfitvOwtmr or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Ilam 19. <br />Y <br />Si nature <br />Printed/Typed Name 9 � <br />March Day Year <br />ZLTXLA <br />DO NOT WRITE BELOW THIS LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />i DTSC W22A (7/92) Tv: P.O. Box 3000, Sacrvmeato, CA 95812 <br />EPA 8700._22 <br />