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1 State of California-Health and Welfare Agency. Department of Health Services <br /> I <br /> Fu, Approved OMB No.2050--0039(Expires 9-30 Toxic Substances Control Division <br /> Pleeas print or type. (Form designed for use on alit itch typewriter). Sacramento,California <br /> UNIFORM HAZARDOUS I. Generator's US EPA ID No. Manifest7A. <br /> . Page 1 Information a the shaded areae <br /> WASTE MANIFEST ( Q Q Q 9 Q fj Document No. of a not required by Federal law. <br /> I^ i 3. Generator's Name and Mailing Address Slate Manifest D cu a m rPacific Molasses 8 T9 30 <br /> 115 W. Washington Stockton, CA. State Generator's ID <br /> Generator's Phone( ) <br /> h 5. Transporter 1 Company Name 8. US EPA ID Number C. State Transponer's ID <br /> i N <br /> rr4 Herbst En_ineerinc , II')r, ) .) I t . D. Transporter's Phone <br /> {. jr, <br /> I H m T. Transporter 2 Company Name 8. US EPA ID Number E. Stale Transporter's ID 000720 <br /> F. Transporter's Phone <br /> I 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> I <br /> Oa Recycletron Oil, IOc , I I„ 0 & I b67 ,3g <br /> ML 13331 North Hiyhlray 3.3 H. ac tact y$' Phohe9 <br /> j OZ Pattarsolt CA. 451 ;) Q 1 t 'T <br /> 12. Conte iners 13. Total 14. I. <br /> I-toUL 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> .s. No. Type Wt/Val <br /> v U <br /> a. Waste diesel/combustible liquid NA1993 State <br /> 0 <br /> °D3 <br /> EPA/Other <br /> N <br /> E b. <br /> R Slate <br /> I A <br /> T EPA/Other <br /> V O <br /> v R c. Slate - <br /> 0 <br /> m <br /> I EPA/Other <br /> Wd. Slate <br /> Z <br /> W <br /> U EPA/Other <br /> Z J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> O a. b. <br /> N ' <br /> W <br /> O <br /> 1- 15. Special Handling Instructions and Addilional Information <br /> Z <br /> I' all JUN 2 5 1990 <br /> ENVIRONMENTAL HEALTH <br /> 16. <br /> PERMIT/SERVICES <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 /> national government regulations. , <br /> If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of wast generated to the degree I have determined <br /> O to be economically practicable and that I have seleaad the practicable method of treatment,storage,or disposal'currently available to.me which minimizes the <br /> I present and future threat to human health and the environment;OR.If I em a small quantity generslar,I have made a good fail effort)b minimize my wsale <br /> I O generation and select the beat waste management method that is available to me and that I can tdrd. j <br /> Printed/Typed Name Signature LZ Month Day Year I <br /> I � .`., C ci 770 <br /> W R 17. Transporter i Acknowledgement of Receipt of Materiels <br /> Z <br /> A Printed/Typed NameSI nature <br /> Q N g Month Day Year <br /> W PO 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> jV T Printed/Typed Name Signature Month Day Year <br /> I E <br /> Z_ <br /> 19. Discrepancy Indication Space <br />�.' F <br /> A <br /> i C <br /> I <br /> i L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T <br /> y Printed/Typed Name 013 en F 45 I Signature Month Day Year <br /> Larr s °r I <br /> DHS 8022 A(1/88) Do Not Write Below This Line 101 <br /> EPA 8700-22 , <br /> (Rev.9.88)Previous editions are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR,WITHIN 30 DAYS <br />