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State of Calibvni aviroamental Protection Agency -7-185-01 See Instructions on back of 3e b•t Department of Toxic Substances Control <br /> Form Ap S No.2050-0039(Expires 9-30-99) s../ Sacramento,California <br /> Please print or type. Form designed for vse o^elite(11-pitch)���Hter. <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information a the shaded areas <br /> UNIFORM HAZARDOUS 1 is so, squired by Federal law. <br /> 9 <br /> WASTE MANIFEST A 197b 2 02 7 ar <br /> 3. Genero;;e Name and Mailing Address BIG VALLEY FORD A. Stale Manifest Document Number;x..^3 5 3^ sF 9 <br /> 3282 AUTO CENTER CIRCLE �`JJMV4J{sVl 1VK1� <br /> B. State Generate,ID <br /> STOCKTON CA CA 95212 <br /> 4. Generator's Phone( 209 956-6711 <br /> N 5. Transporter I Company Name 6. US EPA ID Number C. State Transporter',ID <br /> CO SAFETY—KLEEN CORP. I D 8490 2 D. T'a^'pa1al'sPh.. O 669-5740 <br /> m <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. Staff Transporter',ID _ <br /> _ <br /> �1c.i F.Transporter',Phone - <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Store Fodli ',i 6 3 8 <br /> ¢ SAFETY—KLEEN CORP. <br /> OC5050 SAL I DA BLVD H. Facility'.Phan. <br /> CrMSALIDA. CA 95368 CAT 000613968 209 545-1412 <br /> 11yi 12. Contamcrs 13. T.I.l 14. Ualt <br /> OoU I1. US DOT Description(including Proper Shipping NO..,Hazard Class,and ID Number) No. Type 0 amity Wt/Val I. Waste Number <br /> Lo <br /> ,rate 742 <br /> CI'r a WASTE COMPOUNDS. CLEANING LIQUID DM C <br /> t-- (MONOETHANOLAMINE)B NA1760 PGIII (DO06) EPA/other <br /> 3 G tD008, DO28, DO27DO39DO40) (ERG11154)7. 9*/GL DOO6 <br /> . E State - <br /> m E b. WASTE COMBUSTIBLE LIQUID, N. O. S. 213 <br /> (PETROLEUM NAPHTHA) NA1993 PGIII 7 DM G EPA/other D039 <br /> 14 A (D039. DO08. DOIS, DO40) (ERG#128)6. 70/GALc. 0 state <br /> $ T WASTE COMBUSTIBLE LIQUID, N. O. S. 741 <br /> R (PETROLEUM NAPHTHA) NA1993 PGIII (DO01) DM G EPA/Other DO01 <br /> (DOO6. D008. DCF18. D027DO39DO4O) (ERG# 8) : <br /> ru Star. 741 <br /> W d RQ WASTE COMBUSTIBLE LIQUID, N. O. S. <br /> Z (PETROLEUM NAPHTHA) NA1993 PGIII(DOO1) 3 DM G EPA/Omer DOOi <br /> (DO06, D008. DG18, D027. D039D040) (ERG#128) <br /> 'fionaf Descriptions <br /> Far Mafenols Listed Above K. Handling Codes for Wastes Listed Above <br /> Z A) D008 D018 tA) D027. DO39. DO40 <br /> o (8) D008, 0018, D040 a 14 01 b. 14 O1 <br /> (C) D039 D018 (C) D00b. DOOS, D027, D440; <br /> ). 3 Milli2R;t . c 14 01 d. 14 01 <br /> 2 75. Special Handling lnstrecfions and Additional Information — — — 6 <br /> a <br /> EMERGENCY RESP8800-468-1760 24HR <br /> Z <br /> A: 950 8: 975 C: 10082 D: 10083 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and ore classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nationaPgovernment regulations. <br /> If am o large q fiq r <br /> —ir <br /> generator, certify that I hove prog rom in place to reduce the volume and toxicity of waste generated ro the degree I have determined ro be economical)y <br /> d <br /> practicable and that)have elected the practicable methodof treatment,storage,or disposal currently available to me which minimizes rhe present and future threat Its human health <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> Oavailable to me and that I can afford. <br /> >- Printed/Typed Name !� Signature ^d('/ y r^ <br /> z 7�� �iV�t e,u- (X� / <br /> W T 17. Transporter T Acknowleclerrant of Receipt of Mote tab <br /> w j Prin /Ty Na a Signature it I r <br /> W S <br /> LL 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> Q Printed/Typed Name Signature Month Day Year <br /> QN E <br /> V R <br /> 19. Discrepancy Indication Space <br /> Z E <br /> _ p <br /> c <br /> I <br /> 11 <br /> L <br /> 1 20. Facility Owner or Operator Codification of receipt of hazardous materials covered by this maniFentmensept as noted in <br /> T Prin yped Name Signor. <br /> T <br /> rCS r �/�IS/g��IE. <br /> x t AGjQC/�pR gtNDS HIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> .DTSG 8022A(d/97) l en .tors o su6mif hazardous waste for transport out-of-stab, <br /> eted copy of this copy and send to DTSC within 30 days.) <br /> EPA 8700-22 <br />