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Stat of Cddamio—EnNronmenfd Protection Agency <br /> Sae Instructions on back of <br /> l"� <br /> FamvApprovsd 6M8 No,2050-=9(Expimi 9.3096) <br /> Pleases print W type. Farm designed for use on affte f 12pikAJ"0 Oaparbent of Toxc SV bstarcss Control <br /> Sacramento,Calilorda <br /> EG�,W.,'s <br /> M HAZARDOUS 1, <br /> Generatols US EPA ID No. Manifest pocumetst No. 2. Pogo I Information in the horded areas <br /> TE MANIFEST C A C O O 0171310101614 /� 3 S ' n net required by Federal law. <br /> J of/ <br /> Name and Mailing Address $roseManifest Document NumberENTAL CABLEVISION 5AH O'SHANTER DR. STOCKTON, CA 95210 8, Stab Generator,lD <br /> Phone 2209) 473-4955 <br /> Company Name 6. US EPA ID Number C. Stab Transporter',I <br /> ALLIED PETROLEUM C A L 0 0 0 1 1 2 3 1 4 D. Tron po bls Phone N <br /> J7. Transporter 1 Company Name 8. US EPA ID Number E. StateTronsporbr's ID ; <br /> Q F. Trarupo ns,'s phase <br /> Y 9. DCgn P $ib Address 10. US EPA ID Number G. $f uI <br /> L8xb3166728 <br /> 133331 N HWY 33 <br /> PATTERSON,CA995363 C A 0 0 8 3 1 6 6 7 2 8 H. Facility's Phone <br /> 800474-4444 <br /> Z_ 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> L No. T OuanWt/Vol 1. Wonder Number <br /> J E EPA/Other <br /> °u N b. <br /> b E state <br /> e R <br /> i A EPA/Other <br /> O T C. <br /> O Stab <br /> u R EPA/011ier <br /> Z d. <br /> u State <br /> u <br /> u <br /> EPA/Other <br /> J. A[�Jyr6cnal r/6Da/sc'ripIlls for M/at/�/orals listed Above K. Handling Cod for.Wosbs Listed Above <br /> I Z , Wu �`r T FC l ljc <br /> a. p F b. <br /> ✓5Lr 1 <br /> C. _ d. <br /> 15. Special Handling Instructions and Additional Information <br /> USE APPROPRIATE PROTECTIE GEAR <br /> DESIGNTED FACILTIY EMERGENCY CONTACT 800-874-4444 <br /> GENERATOR EN£RG'NECY CONTACT # 209,.473-4955 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the canbnts of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> C packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> i <br /> I If 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 to be <br /> economically practicable and that I have selected the practicable method of treaboent,storage,or disposal currently available to me which minimizes the present and future <br /> s threat to human health and the environment;OR, R I am a small quadity,generator, I have made a good faith effort to minimize my waste generation and selecAtbe best <br /> waste mono ement method that is available to me and that I can afford. <br /> I PRritgd/Typed Name Si mtis ' <br /> hfI' q Month lDaY� Year <br /> il_:LC.' K N L L.lir , i'4-L .)L L`1 f i': �./Jtc,f`. g ;N�;d,<..� --� 1++ 61 <br /> J 7 I f 117 <br /> i T 17. Trans Doer 1 Acknowl d emenl of Rec ' t of Materials (/ <br /> 1 A Printed/Typed Na Signature <br /> N Al XY <br /> Month Day Year <br /> P <br /> j p 18. Trans orter 2 Acknowled ement of Recei t of Materials ` <br /> E Printed/Typed Name $ignotine Month Day Year + <br /> R <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facili Owner or O erctor Certification of recei t of hazardous materia co is manifest exce f m noted in Item 79. <br /> T EdpfedATyped Name <br /> Y n / - Signolure <br /> �' <br /> DO NOT WRITE BELOW THIS LINE. <br /> f5C 8022A I9/9q <br />'A 8700-22 <br /> Green: TRANSPORTER RETAINS <br />