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State of California—Emiranmontol Protection Agency <br />Farm Approved OMB No. 2050-0039 (Expires 9.30.991 See Instructions on back of , -e 6, bepartmmt of Toxic Substances Contral <br />Please print or VTw. form designed (or vu on elfin ()2-pikhl ty.9 S _01 <br />_ Sac.amenm ('aliMrnia <br />C <br />n <br />Y <br />Q <br />C <br />C <br />m <br />a <br />)4 <br />JZ <br />)C <br />)U <br />�Z_ <br />x <br />3 <br />O <br />W <br />N <br />a <br />0 <br />0 <br />m <br />s <br />Z <br />Z <br />W <br />V <br />w <br />N <br />Z <br />OL <br />N <br />W <br />Z <br />Z <br />O <br />Z <br />z <br />w <br />x <br />U <br />a <br />0 <br />a - <br />V <br />Z <br />w <br />C7 <br />0 <br />O <br />w <br />N <br />Q <br />V <br />tA <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/991 <br />EPA 8700-22 <br />Ty -F o F 3•+ r+-�k A'9C A� M vFc 1 <br />UNIFORM HAZARDOUS <br />1. Wnerotoi s US EPA ID No Manifest Document No. <br />2. Page 1 <br />Information in the shaded meas <br />WASTE MANIFEST <br />C R 0 29 ( <br />of 1 <br />it notrequirdbyFederallow, <br />3. Generators Nemo and Mailing Add.. ADVANCED INTERCONNECT, TR CH <br />A. SbM1 Manifest Document Number <br />555 CARNEGIE ST. <br />20532578 <br />BOX 952 <br />P .}}0�E , <br />8. Stale G...ratai. ID <br />pp <br />M4.'CCeMi6rt Phonal I CA 95336 <br />5. Transporter 1 Company Name 6. US EPA ID Numis.r <br />C. State Tranporsers ID IRewrwd-I <br />SAFETY—KLEEN SYSTEMS. INC "Cp 10yCpj5j5pI I 1D. <br />Transporters Phone <br />7. Transporter 2 Company Name 8, US EPA ID Number <br />E. Stab Transporter'. IDM-- I <br />F. Tromport.rs None <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />718501 <br />rAT00101109164 <br />SAF ETY-KLEEN SYSTEMS, INC. <br />H. Fai Phone <br />5030 SALI'DA BLVD I'A <br />?1p3 0 <br />11 <br />r 0360 <br />11. US DOT Description lincluding Proper Shipping Name, Hazard Class, and ID Number) <br />12. Conta <br />in.rs <br />13. Total <br />Quantity <br />le. Uni <br />Wt/Volt <br />I. Warta Number <br />No. <br />T <br />a <br />Stab <br />WASTE'COMEUSTI3LE LIQUID, N.O.S. <br />EPA/Other <br />G <br />(PETROLEUM NAPHTHA? NA1993 PGIII RQ <br />1 <br />D <br />/� <br />N <br />b. <br />State <br />E <br />EPA/Olh.r <br />R <br />A <br />T <br />State <br />EPA/Odor <br />It <br />d. <br />State <br />EPA/Other <br />1, Additional Descriptions for Materials Listed Above <br />K. Handling Codes lar Wastes UsW Ahove <br />a. b. <br />IA) D018 D039 D040 <br />14 01 <br />c, <br />d. <br />i <br />15. Special Handling Instructions and Additional Informotion <br />MFST R/T#099582175 0002-0654-56 <br />E MZ RGENC': R?SP 330-458-1 50(24 HR). IF UNDELIVERABLE RE'^URN TO GE:7ERATJ2. <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the conl�ams of ii < nsignmenl an {ally an ..tr ( described above by proper shipping nom. and ars classiFed, packed, <br />marked. and labeled, and era in all respects in proper condition For transport by high.ay according ta applicable international and rational govsrnmenr regulations. <br />If I am a large q.an8 generator. I certify that I hon a program in place b reduce the volume and toxicity of wash generated b the d.gm I hove determined to b. economlcall <br />I= the disposal b die future threat to human hanU <br />practicable and that selected practicable method of treatment, storage, or currently ovoilable me which minimizes present and <br />and the im. ronmenr, OR, if I am a smaquantity generator, 1 have made o goad faith A." to minimize my waste generation and select the best waste management method that is <br />available to me and that I can Mord. <br />/ <br />Prinmd/Typed Name 1' ii <br />Signature f - 7� <br />may. Year^ <br />^� <br />T <br />17. Transporw I Acknowledgement of Receipt of Materials <br />Printed/Ty qma / <br />Signature <br />Jnr <br />B <br />18. Transporter2Aclinowied ement of Recei t of Materials <br />R <br />T <br />Printed/Typed Nome <br />SignatureMend <br />Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Fooli Owner or Operator Certi{i,otion of receipt of hazardous manriab <br />covered b this manifnt ..Pt os noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/991 <br />EPA 8700-22 <br />Ty -F o F 3•+ r+-�k A'9C A� M vFc 1 <br />