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11IC/ „ • R7T CSO. � I"IOIJr R. Bg_i1N <br /> Drtmenl <br /> of coo Services <br /> 4/392 saetentr. Division <br /> Ate# 61715ToxicbcamntoCalifornia <br /> � 204-4728-0502-7-l' 17 Sa <br /> areas)Slate of Callloml6—Health end Welfare Agency typewriter.) Maniteat 2.Page 1 Information in thered sby Fede al <br /> Form designed for use on ellfe ff2-Ditch)fyP Document No. le not repulred by <br /> please Drinl or lyDe f A.Generator's US EPA ID No. of law. <br /> UNIFORM HAZARDOUS A.State Manifest Document Number. <br /> WASTE MANIFEST �7EFATZ2� SM <br /> 3. Generator's Name and Melling Address <br /> BM 6249 SHEM STATI,OU 0.states Generator's 10 q'p,}[ YD NO. <br /> � <br /> OIL COMPANY, 1071 N. MAN T " h-010777 <br /> CAIIc7aj CA 90749 ,• r a ; <br /> —� US EPA ID Number C.State I ranaporter's ID <br /> d. Generator's Phone( 1 e. 633-• _ n <br /> 5. Transporter 1 Company Name A T 4 t:1 1 (J 6 .Q D.Transporter',PhGne 15 <br /> Z C i+ ^- <br /> g U5 EPA ID Numoer E.Slate Transporter's ID <br /> F.Transporter's Phone <br /> 7. Transponer 2 Company Name G.State Facllily's ID <br /> 10 US EPA ID Number / <br /> 9. Design led Facility Name and Site Address A1C , <br /> cls-IATCAE, �17„E IWI AGO, I Tz H.Facility's Phone <br /> r-� RD fl00/222-2964 <br /> 352510LD CAT000646117 1d <br /> 932.39 12.Containers o Unit L <br /> CITY CA Total Waste No. <br /> No. Type Ouentity Wtivol <br /> 11.US DOT Description(Including Proper Shipping Name, Hazard Class,and IC Number) r / <br /> F001i,F003, <br /> G a. m - -^ i G FY105 .. <br /> E O �_$r PJA9139 0 0 1 T <br /> E iuizardoiss . 21--e, lint'id, n. <br /> A <br /> T <br /> 0 <br /> R <br /> 1X7TN F= % { / ( LTH <br /> d. ENVIE �T ERVIGES <br /> gJ*gir�yTly my?aTi[XXJS 6JASTr P ^ST #1-1732 K.Handling Codes for Wastes Listed Above <br /> ted <br /> J. Additional Descriptions for Materiels LisAbove .. . <br /> WATER 60-908 <br /> 0 Om 15-308 <br /> 'I ScmD4,-1f/ASSOCIATM, DEBRIS 25-408 ' <br /> r� T <br /> 15.Special Handling Instructions and Adtllgonal Information <br /> AVOID Lamm= VIM- EYES AM S MI- <br /> C'E4 Pb'DFILE Saul #LAx-G25006-022 <br /> N:1 hereby declare that the contents of this consignment are ful <br /> 16.GENERATOR'S CERTIFICATIOly en0 accurately tlescribetl above by <br /> classified,packed,marked,and labeled,and are In all respect'in proper condition for transport by highway <br /> proper shipping name and are <br /> according to applicable International end national government regulations.; - _ cilrtlficaftl <br /> under Section 300all quantity <br /> e1 raor who as been <br /> haveexempted <br /> by Inatute place to reduce the volume andor regulation from the ytoxic toxicity of asteo make agenerated titon the degree <br /> al currently available to me whit <br /> have determined to be economically practicable and I have selected the method of treatment, storage, or dispos <br /> minimizes the present and future threat to human health and the environment. Alonih Dey Y <br /> Printed/Typed Name Signature <br /> yl' <br /> D. L. Robinson I <br /> 1 /1013-,)l ' <br /> T 17,Transporter 1 Acknowledgement of Receipt of Materials Month Day y <br /> A Signature _ <br /> A Printed/Typed Name <br /> I - L77 <br /> 0 10.Transporter 2 Acknowledgement of Receipt of Materials <br /> a Signature Month Da <br /> y 1 <br /> T Printed/Typed Name <br /> E <br /> R <br /> 19.Discrepancy Indication Space l <br /> r 20.Facility Owner or Operator: Cenillcatlon of receipt of hazardous metprjels covered by this manifest except as noted in Item 15. <br /> T SI nature Month Day <br /> Printed/TypeO Name � , ( -. 1 <br /> C!�S zn2z A 111.85), YELLOW TSDF SENDS THIS CCPV TO GENERATOR WITHIN :1�DA.YT <br /> (FPA v 700-221 <br />