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I t Slate of California—Enviranmentol Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30.99) t ; <br />Ple t ntype ft•. F. - 0 <br />Form designed for use on elite 112 -pitch rife <br />See Instructions on back of page 6. Department of Toxic Substances Control <br />Auk Socmmento, California <br />ase <br />pun <br />„, <br />enaralor's US EPA ID No. <br />; % <br />Page I Information in the s v e areas <br />is not required by Federal loWASTE <br />7MEOnifeslDocument2. <br />HAZARDOUS I <br />MANIFEST :P 1.' 0-.434 <br />aft <br />rator's Nome and Mailing Address ,. E. rirj'RAL V?\LLEY WASTE S�)(,A. <br />Stale Manifest Document Number2964589 <br />rANIFORM <br />F. TURNER RD� <br />B. State Generator's ID <br />X 2 9'1 tf L) 1 <br />CA 95241rator's <br />Phone fl O 9 lel <br />rate Transporter's ID [Res_=rved.] <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />D. Transporter's Phone <br />r• n <br />.AFETY <br />—KLEEN SYSTEMS T. NC. TX 0 O.0 0 <br />8. US EPA ID Number <br />E. State Transporter's ID [Le,__ <br />7. Transporter 2 Company Name <br />-F.-Transporters Phone <br />9. a d F cili Name oisd 5ibAddress 10. US EPA ID Number <br />u501-4, (\�/�fL'n4I`��k <br />G .Stale Facility'sID I U;jr <br />` <br />H Fa y_s Phone <br />Liu Ts$7 F3t�2 ESiT7j�pi1-3f � �-L <br />414 C :r (=tiLI <br />tainers <br />13. Total <br />74. Unit <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />Quantity <br />Wt/Vol <br />I. Waste Numb rtate <br />Type <br />aZION-RCRA HAZARDOUS WASTE LIQUIDT <br />IN.. <br />r (n � <br />EPA/other <br />OIL,'JATER,SLUDGE(NOT DOT REGULATED) <br />E <br />State <br />N <br />b. <br />EPA/Other <br />E <br />R <br />A <br />state <br />i O <br />c <br />EPA/Other <br />R <br />State <br />d <br />EPA/Other' <br />i <br />s <br />K Handling Codes far Wastes <br />Listed Above <br />J. Additional Descriptions for Materials Listed Above <br />b. - <br />p <br />4r4— 0 <br />i <br />t <br />< <br />d <br />15. Special Handling Instructions and Additional Information <br />MFST R/T$104401752 0002-6198-44 <br />L <br />,MERGENCY RESP 8i.)0-468-1.750(24 HR), IF UNDELIVERABLE RETURN TO GENERATOR. <br />CARRIERS AS NECESSARY. <br />K CORP AUTHORIZED TO RETAIN LICENSED SUBSEQUENT <br />I& GENERATOR'S CERTIFICATION: hereby declare That the contents of this consignment are fully vnd accurately described above by proper ship ing n.... nd ora classified, packed, <br />international and nation government regulations. <br />S <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable <br />J <br />I certify that I have a program in place to reduce the volume and toxicity of waste generated m the degree I have determined to be economicallyy <br />large the and future threat to human heolth <br />�- <br />If I am o quantiry generator, present <br />and that ave selected the practicable method of treatment, storage, or disposal currently available to me which minimizes <br />select the best waste management method that is <br />n <br />practicable <br />and the environment; OR, if I a a small quantity generator, I have made a good faith effort to minimize my waste generation and <br />n <br />D_�. <br />available to me and that I can a8ord <br />Month ay) Year <br />ai Ul <br />• ante ,YP d Nome - .✓ Ssg� Nr Gr'--"-.,� 1 J ' �. <br />.i G r !.. <br />Zel.-��. <br />!11 ..:chi <br />iii✓� l <br />L <br />i 77. Trans Quer I Ack owled ement of Recei t Materials Month) oDay\� Y arj <br />q Printed/Typed Name Signature LIe <br />i <br />„ �,^_ <br />� <br />s \�C/1f l -.'ill,,///✓ <br />- <br />Y <br />p 18. Trans Doer 2 Ackaowed a ent of Recei t of Materials Month Day Year <br />O <br />R Printed/Typed Name Sigoatore" <br />JJ <br />� <br />E <br />g <br />U19. <br />Dix:.. my Indication Space <br />Z <br />_ <br />F <br />A <br />C <br />I <br />L <br />20 Faali Owner or O emtor Cert hcafion of recei t of hazardom materials <br />o d b this manifest exce t as at Item 1 - Month ,.D4y._.. Year/ ! <br />T Pnntad/TyRed Name - I 1 <br />`, <br />Signature <br />/ _,-.'`�, e�-. l- f / `7. <br />Y !!.i 1�r 'w'- �. f Q. .. iJ' 51�.a <br />+✓l/� . <br />DO NOT WKIlt nthUW Iola t.II\C. <br />Yellow: T5DF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generator who a6mit hazardous waste for transport out of -state, <br />DTSC 8022A (1/99) produce rompletad copy of this copy and send to DTSC within 30 doys.) <br />EPA 8700-22 <br />