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(tApues 9-30-91) and tftstfuctions on N,ck of Pago 6 Department of Health Service <br />it print or type. (Form designed for use on (f2 -pitch typawriier). and Front o go 7 Toxic Substances Control Divisio <br />UNIFORM HAZARD OU 1- l3ene1610r'4 US EPA 10 No. Sacramento, Californr <br />' WASTE MANIFEST Manifest 2 Page t <br />iC A C 0 0 0 1 Document No. Information M the shaded erase <br />3. O n rotor's Nasme�ayndy�Mr�elill�n��Addrlelaws� !yam p9p� 1���5-r�4 3 0 0 0 0 1 of 1 is not required by Federal law. <br />I V'lJIV1TI m JCB SITE: BRJENER' S STOCKTC)N A. Stet. Manifest Document Number <br />3201 Fosteria Way <br />n, CA 94583-1386 7676 Pacific Ave., 8 <br />`t 4' oe • Ph— ( 415) 866-4300 Stockton, CA B. State oen«alor's 10 <br />8. Tramp of 1 Company Name <br />H 6 H Ship Service (��y� Y 8' UB EPA to Number Port«,• w <br />i I � C. etata Trona <br />t �•.7rutaRorl*r•2 Company,Nafne.M..-.,. ,, ,:, , n CAD 0 0 4 7 7 1 1 6 8 D. Twnaportei a phone 003759 <br />8• US EPA ro Number 415 543-4835 <br />E. State Tranaporter's 10 <br />r <br />F. ftansporter's Phone <br />9. 0ee19nated Fe tality Name and Site Address <br />J H E H Ship Service Cenpany 10. US EPA ro Number G. Stat. F.autY. ro <br />220 China Basin Street C <br />San Francisco, CA 94107--M Fu <br />ara,Y o Phone <br />CAD 0 0 4 7171 <br />1 1 6 8 ( 415) 543-4835 <br />U. 11. US OOT Description (Including Proper Sq 12. Containers 13. Total ta. <br />Shipping Name, 1lazerd Class, and 10 Number) Quantity Unit L <br />RES I CUE DIESEL TANK Ne' TYPe w..t. No. <br />wt/va <br />�3Et N (CALIFOMIA ONLY REOJL.ATED Wim) State <br />P 512 <br />W. E b. <br />A <br />eD T <br />N O <br />f . <br />,}, <br />Iw1�l <br />N <br />0111TIP1110 <br />ax <br />•�► 1'` <br />0. acetlsta Listed Above <br />I K. Handling Codes for Waeles hated Above <br />W10,000 gallon tank last containi b. <br />.... C. d.01O <br />- <br />< t8: Special Handling Instructions and Additional information <br />Z <br />W ' <br />APPI UPR I ATE PFUMICT I VE C LDTH I NO AND RESP I MTM. <br />U 18. <br />j GENERATOR'S CERTIFICATION: I hereby doctor, that the contents of this consignment are fully and accurately described above b <br />and are ooverclassified. packed, marked, and lebebd, and ore in ag respect, in proper condition for transport by highway according to applicable international and <br />H national government regulations. Y proper shipping name <br />¢ It I Am a large quantity generator, 1 certify that I have •program in <br />to be economicopy practic,bls and that 1 have selected 1M Dace to reduce the volume and toxicity of waste generated to the degree 1 have determined <br />Present and future threat to human health and the environment.cppabl� ame�hsma sof mall nt, storage, or disposal currently available to me which minimize, the <br />generation and select the best waste management method that O available to ma and that 1 can afford! have made a good faith effort to minimize my waste <br />W <br />Printed/ Typed Name <br />t, <br />Wn tar <br />I If i (J Month Day Year <br />1 nT 17. Transporter 1 Acknowtodgemant o <br />A Printed/TypedT No <br />me <br />LL SN KEVIN E. JQ+SCN <br />r! P <br />O 18. Transporter 2 Acknowledgement 01 <br />0 T Printed/ Typed Name <br />E <br />Z <br />19. Discrepancy Indication Space <br />F j <br />A <br />C <br />I <br />L <br />T1 20. Facility owner or Operator Certtion of <br />Y I Printed/Typed.Nerna <br />8022 A (1 / 88)Tr- <br />8700--22 <br />9.88) PreVloue editions are obsolete. <br />Signature <br />Of hazardous materiels covered by this manifest except as noted in Item 19. <br />'Not Write Below This Line <br />[01 91 21 01 81 c <br />Month Day Year <br />0912101819 <br />Month Dsy Year <br />White: TSDF SEIIS COPY TO DOHS WITHIN 30 DAYS <br />To: P Box 3000, Sacramento, CA 95812 <br />