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State bf CAIROmle--Health and Welfare Agency <br /> Form Approved OM13 No.2050 Tank See Inetructlone on bstck of Pa s 6 <br /> —0039(Expires p-� g Department of Health Service <br /> Piea3e print or type. (Form designed for(186 one 2-pffch typewriter). and Front of 07 Toxic Substances Control Divisic <br /> Sacramento,Californl <br /> UNIFORM HAZARDOUS 1. Generator'.US EPA ID No. Manifest 2. Page 1 <br /> WASTE MANIFEST Document No. Information In the shaded erase <br /> of is not required by Federal low. <br /> 3. Nnerotor's Name and Moiling Address 8tif6 Mih a tl u M <br /> Moorman ' s Ilater Systems " <br /> 2120 W_.1cox Rd , Stocton , CA 95205 .a IN admikors-101 <br /> 4. Generators Phone( 2 0 9 931 3210 u;. V, T i <br /> 6. Trsnsporter 1 Company Name 6. US EPA ID Number ct, stets rills ilf i ro <br /> N <br /> O.C.S. IC I Al q) ow nips 4 4 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number Qri� lists Tri�ip8tlit'f Iq i t ti,> } x.' �^ <br /> g r tilfa)9 M'i 4 s rf y,.., p <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number 0. (iii i Htyi err «.. <br /> iottlty'e tbM <br /> 7 5 µ „}yyf6r r <br /> I � 7 <br /> Z <br /> 12. Containers 13 Total14. r <br /> N t 1. US bOt Description(Including Proper Shlppinp Name,Hazard CleaA,and Ib Number) Ouentlty Unit <br /> UA No. Type Wt Vo1 <br /> E Calif regulated waste only N.O.S . } <br /> PA/,( ar a <br /> C70 NG + <br /> E h. <br /> fv R 8ti 4.'} <br /> r w <br /> A <br /> v A/O1hA„,'Alt 41 <br /> cv R �; . <br /> 7 <br /> C. <br /> 8Hte <br /> x t <br /> Q r try r <br /> d 8141 <br /> w rk <br /> w <br /> EPA/ <br /> Z a n g�1 i ptylone 16,M4eiQ�an4 411 A156" <br /> y (np CMOs,tot11,1616111;d Aura k <br /> ' WI+C,% W� CJ t• r 1 � t� �� 5+y' r � r ':� -1 ° w <br /> r$y`. ✓ ° { �' ,�h y"1 vrP �+ '' i • , <br /> °' I Aw <br /> 14AAt 6 f d 6 yg <br /> 2 ck �• �� k As t` ,� , 1�l'� pY �f„ <br /> .• � 'x >htW� <br /> 16. Special Handling Instructions and Additional Information <br /> Z <br /> W Refer to invoice t 7818 <br /> J <br /> U td. <br /> bENt•i+Atod's CEAt1ft1cAtidN: 1 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 ell respects In proper condition for transport by highway according to applicable International and <br /> Q. <br /> national government regulations. <br /> IIt 1 am A large quantity generator,1 tartly that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> 0 to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimize&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 /> V generation and select the best waste management method that Is available to me and that 1 can afford. <br /> 2 <br /> W Printed/Typed Name Signature Month Day Year <br /> W <br /> W T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> Q A Prinfed/Typed Name <br /> N Signatur Month Vey Year <br /> W S Y ) <br /> .4 k141;�"' y'r <br /> W 0 t8. Transporter 7 c now. gement of Receipt of Materiels <br /> U E Printed/Typed Name Signature Month Day —war <br /> — <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> L <br /> 1 2n. Facility Owner or Operator Certification of receipt of hazardous materiels covered by this manifest except as noted In Item 19. <br /> T <br /> Y Printed/Typed Name Signature Month Day Yee" <br /> DHS 8022 A(1/88) <br /> EPA 8700-22 Do Not Write Below This line <br /> (Rev.9 an)Previous editions are obsolete. White: TSDF SENDS THIS COPY TO DOHS WITHIN 30 DAY....": <br /> To: P.O. Box 3000, Sacramento, CA 95812 <br />