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$lata 9f California—Environmentat Protection Agenry <br /> t; Form Approved OMB No 2050-0039{Expires 930.991 See Instructions on back of page 6. .� <br /> P 9 Department of Toxic Substances tpntryt <br /> Please print or type. corm designed for use on elite(I2-pitchl typewriter. Sacramento,Californiq+' <br /> UNIFORM HAZARDOUS I. Generator's US EPA ID No. Manifest Document No 2 Page 1 Information in the shaded stemr <br /> ,r WASTE MANIFEST OR l: a 8 8 0 0 1 1 snot required by Federal law <br /> 10 1 <br /> of s <br /> s 3. Generator's Name and Mailing Address Oak Park Gas A Convenient A. State Monif"I Document Number 2216 6y y' <br /> 3212 V. California St. <br /> Stockton, CA 95204 B. State Generator's ID v;} <br /> 4. Generator's Phone( I 209 941-2694 <br /> N S. Transporter 1 Company Name 6. US EPA ID Number C, Stole Transporier's ID fR§tlgfy .1 a. <br /> OD Belahire Environmental Sve. 4 6 e <br /> D. Tronsporter's Phons <br /> 7. Transporter 2 Company Nome 8. US EPA Ip Number E. State Transporter's ID[Ru v d.� s <br /> ;} <br /> J <br /> J F. Tran spotter's Phone <br /> Q <br /> U 9. to y dress 10. US EPA ID Number G. Stole Facility's IID i <br /> E� � 1784 HEST FIRST STREET <br /> t •ZO AZUSA,CA 91782 C A D 8 0 8 3 0 2 9 0 3 ty' <br /> H. f udli s Phons <br /> �, ...... -44 <br /> U 11. US DOT Description ncludin Proper Shi n Name.Hazard Class,and ID Number) 12. Comainers 1 3. Total 14. Unit <br /> P li 9 P PP' g Na. Type Quantity Wt/vol f. Was <br /> yZn.p.6 $la <br /> Hazardoub wasteO <br /> 9 JIA3077 P.G. III fi <br /> (D818, >Benx4ne) i 1 D - P EPA/Otfsv <br /> ei E <br /> p b' <br /> stow <br /> CO <br /> EPA/Othw <br /> s v A, <br /> `t — <br /> T c <br /> go 0 <br /> R <br /> EPA/6't C" <br /> w d. $tate w ^ <br /> Z <br /> V ,EPA/ <br /> 1EsddirQnaI Descriptions fos Moteriafs Listed Above K. Handling Codes For Wastes Listed A tow i <br /> _ 0. <br /> x <br /> LU <br /> of <br /> C. d. t <br /> A <br /> Z <br /> p ��'1af,f{np�lyg� rr f;aesp�iY�ddil;onollnEor�as�� MMKY PHC)1•( L Site: <br /> �U f t Oak park Cas L Convenirlt e <br /> a AR ALL APPROPRIATE 949-450-1810 (K-F 8as-5ps) 3212 N. California St. <br /> W PROTECTIVE CLOTHING 949-753-5826 (24-hours) Stockton. CA 95204 � <br /> S :Y <br /> !S <br /> >• J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of Ibis consignment are fully and accurately described above by proper shipping name and are classified.pocked <br /> IIIQJJJ marked,and labeled,and are in all respects in proper condition For transport by highway according to applicable international and notional government regulations. $ <br /> _ S <br /> J <br /> e <br /> -� IF I am a large quantity generator,I certify that I have o program;n place to reduce the volume and toxicity of waste generated to+ho degree I have determined to be economic _ <br /> CL practicable and that I have selected the practicable method of treatment storage,or disposal currently available to me which minimizes the present and future threat to human het <br /> and the environment;OR,if I am a smolt quantity generator,I hove made o good faith effort to minimize my waste generati n and salect the best waste management method that is <br /> 0 <br /> available to me and that i can afford. r 'C <br /> r Printed/TypV <br /> VV hla me <br /> 1 <br /> A <br /> Zul <br /> { <br /> [, 17 Tronsporte 1_ cknowled ement of a ei t ctMateriols '— \ <br /> i. Print fad o 1, '1 gFalure - -�" at <br /> Day <br /> W <br /> sp 18. Trans or ter 2 Acknowl0gement of Receipt of Materials <br /> CJ Printed/Typed Name/ Signature Month Day Year r <br /> Lu <br /> 4#•�.. V 19. Discrepancy Indicution Space <br /> ft... Z f <br /> E� <br /> EF 20- ocility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. „( <br /> �Y Printed/Typed Name Signature Month Day Year '4� <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A(1/99) Blur: OLl�ita )r :ENW; :,•f!; '. .f Y ' UgtS <br /> EPA, 700-22 o Pii. �o% 41il, ,ccriraNntn. <br /> .: : <br /> n, <br /> Gold wk) oo: Z S Z0-90-33a <br />