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Sore r Co.,farnia—%nv,ronmenrm"'mt:on Agency <br /> Farm Acmevea CMB No._OSD-0039!ExPnes 9-30991 See Instructions on back of pa Deparm,enr,of Toxic Substances conn., <br /> • Prean cn%,or ,". Farm deugnaa/or vu an aide 112-pitch)yP Sacramento,Califarnra <br /> j I. Ganeraror s U$EPA ID No. Manifeu Document No. 2. Page I Information in the shaded areas <br /> UNIFORM HAZARDOUS nane9abed by Federal law. <br /> WASTE MANIFEST - C A IC 0 10 1 3 1 Ib C 1= 1617 11 19 1 5 . 1 of I. <br /> . Generator's Name and AIcAirg Address A. Sime Manifest Document Number -" <br /> 3..e-V1ILI FRCS. 98891951 <br /> 0 3212 RD.y HGlyi?3r CA 97220 B. stem.Gen.rmon tourl - <br /> 4`1 A. Generator's Phone 1 209 I 362-1720 - <br /> n <br /> N 5. Transporter I Company Name b. U$EPA ID Number G Staro Transportels 10 <br /> Mrs <br /> a' r A D 9 5 % -' 1 7 2 5 - D. rransponers Phone 01 <br /> o I P. C:AJ OL - I - • (209) 60/ 06�.. - <br /> aa _ B. US EPA ID Number E. State Tr...pnersl0 - <br /> 7. Transporter 2 Company Name _. _. ." o <br /> Q <br /> 1 1 F. Transpmtere Phone _ <br /> U 9. Designated Facility Nanta and Sita Address 10. US EPA ID Numoer G. Slate F till D � —/ , <br /> ICiiTJSTIP AL/� S IMCE OIL CO. z - 2 <br /> Z 1700 S. SV� ST H. Fis,,h Phone <br /> CT)O ^_S ?TlGSe Ga 90023 C ? D ( 'S 1' _ I� 2 i U 3jZ'S <br /> �LL :I. US DOT Description 12. Conmmers 13. Total IA. Unit - <br /> M V i p r (including Proper Shipping Name.Hazard Class,and ID Number( No. Tape Ouanury I Wt/Vol I I. Waste Number <br /> Cp z a Sime =223 <br /> EPA/Other <br /> 31 G �(tti'r9iER & SLUDGE) - - 10 10 1. I <br /> E State <br /> N I Q o. I EPA/Other '.. <br /> 61 T I `. Slate <br /> m 1 0 EPA/Ocher <br /> Cis d. State <br /> Z <br /> j 1 I Prefabs : - <br /> rA L Additional Descriptions for Materials listed Aban. _ K. Handling Codas far Wastes Listed Above <br /> 01 -TAN{ BCT1Ci�! ,JAS=' - .-.: <br /> NI - <br /> _ - <br /> z _ BICISATE d. .. .. .� �. <br /> Q <br /> ZI S Special H al' g Instructions and Add t anal Information <br /> Z Z CY CaNrACT: (209)5x1-91A5" <br /> = 5 C.'?.G. 171 <br /> � I <br /> J <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment me rn'"and accurately described above by prop"n""pmag nameand are domifiisd,packed, <br /> Q marked,and labeled,and ore in all respects in proper condition For transport by highway occording to applicable international and notional government regulations. <br /> U <br /> J1 IF I am a large quantity generator,I certify that I have a program in place to reduce me volume and toxicity of waste generated to the degree I have determined to be economically <br /> N I practicable and that)have selected the practicable method aF treatment,storage,or disomai currently ovatla6le to me wnich minimizes rhe present and future threat to human health <br /> and the environment:virment:OR,if I am a small quantity,generator,I have made a goad faith edart to mimmsze my..,,a generation and select the best waste management method that is <br /> ca -available to me and that I can afford. <br /> 0 tvimsth <br /> Upri��/Tvpnad NYe , TL/ vs F Signa�l/`!L ��I' VVJ / Day '/ <br /> Z I '!/i. I N I It <br /> j3 T 17. Transporter I Acknawled mens of Recei of Mmeriofs <br /> X 1 7rimed/Typed Nna <br /> $igNre Day <br /> w // e <br /> W S <br /> P <br /> W 0 B. Transeoner]Acknowled a ent of Receipt of Materials <br /> 0 B 1 Printed/Typed Name Signature Month Day Year <br /> U.1 <br /> QI e <br /> („) 19. Disttepancy Indication Space <br /> A <br /> C <br /> nn. Facility Owner or Operator Certification of receipt of hCzordaus materials covered by this avfesr exc.,as noted in Item 19. <br /> T Tinted/Tyaed Name �� Signature J Month Day Year <br /> Y r �^ /, i ��y� C4 <br /> 1 7 <br /> DO NOT WRITE BELOWTHrS LINE. <br /> aw. CSDP SENDSC"T! -O �cNERATOR WITHIN 30 :ars. <br /> .Generaars ma\:ucmir na_oracus .yasre Far mantra,♦our-ai-srare. <br /> DISC 3022A(4/97) .r.cvice cam.._.e:ec [ v of his and send ro JTSC ..ith,n 30 devs.; <br /> EPA d7C0-22 <br />