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State of California---+iealth and Welfare Agency Department of Health Services <br /> Folin Approved OMB No.2050-0039(Expires 9-30-91 - Toxic Substances Control Division <br /> e,print or type. (Form designed for use on elite(12-pitch typewriter). Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST ,; Pofument N"ito. , of is not required by Federal law. <br /> 3. Generator's Name and Meiling Address A. State Manifest Document Number <br /> LODI IErLAL TEM. 89578356 <br /> 213 l ` LY STPJ:T j LODI, C� �� ?KA 95241 B. State Generator's ID <br /> 4. Generator's Phone( 2 U) —1?4 ,)S t141,611 ( l c <br /> 1 711 <br /> h 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter'&ID <br /> C14 K 7? $ T'Q 7 D. Transporter's Phone <br /> O 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> OP <br /> F. Transporter's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> C.0 a <br /> C.0 US ECOLOGY <br /> ltM� U S HIGrA Y 95, 12 11ILES SOUTH OF BEAM, NEMA H. Faci Phdri <br />`'JZS9 M13 N " / 1 — 'f Z <br />( 0 12. Containers 13. Total 14. I. <br /> LL 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> No. Type Wt/vol <br /> U a. State 1 <br /> Q�Z J 1 _ <br /> 0 E HAZARM US WASTE SOLIDS � dos '1A 9189) EPA/Other <br /> 3 N Mt t ao t <br /> E b. <br /> State <br /> o R _ I <br /> A ! <br /> Ti -- EPA/Other <br /> N D a- r`i t: '1 to��r r. Is 01013ID If-t 0 1C Clio <br /> f <br /> v R c. <br /> State <br /> m <br /> - EPA/Other <br /> w d. State <br /> t- <br /> Z <br /> w <br /> U EPA/Other <br /> W <br /> Z J. Additional Descriptions for Materiels Listed Above - K. Handling Codes for Wastes Listed Above <br /> Q - r !: a. b. <br /> w `BASTE STBEAN # 07-005-1628 <br /> cc WASTE STRA14 DESCRIPTION: HATER BASE PAINT C. d. <br /> Z FULLERS EARTH <br /> 0 <br /> F- 15. Special Handling Instructions and Additional Information <br /> Q <br /> Z <br /> W <br /> H <br /> J <br /> J <br /> U <br /> 16. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> Nnational government regulations. <br /> cr It I am a large quantity generator.I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> p to be economicaily practicable and that I have selected the practicable method of treatment,storage,or oisposal currently avanaole to ve wmcn minimizes the <br /> } present and future threat to human health and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste <br /> U generation and select the beat waste management method that is available to me and that I can afford. <br /> Z <br /> W7 <br /> CPrinted/Typed Name Signature Month Day Year <br /> M --. I^. <br /> -/ <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> Z <br /> ZA Printed/Typed Name. Signature Month Day Year <br /> LL S 1`1- k rC I t <br /> O <br /> W O 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> < R Printed/Typed Name Signature Month Day Year <br /> E <br /> Z_ <br /> 19, Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I 20. Facility Owner or Operator Certification of receipt of hazardous materiels covered by this manifest except as noted in Item 19. <br /> Month Day Year <br /> T :::::��� Signature <br /> y Printed/Typed Name <br /> Do Not Write Below This Line <br /> DHS 8022 A 0/88) <br /> cPA 8700-22eVious editions are obsolete. <br /> -v.9.881 <br />