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Y a •, J a 3� <br /> willornis--Health and Welfare Agency See Instructions on Bat Page 6 Department of Health Service <br /> .droved OM8 No 20,50-00311(Expires 9-30•0 and Front of Page T Toxic Substances Control Divisio <br /> ,se print or type (Form deslgned for sae on 0*0(02-pitch typewriter) Sacramento,CalifornI <br /> UNIFORM HAZARDOUS 1 Generator a US EPA ID No Manfred 2 Pao* 1 Information in the shaded areae <br /> !F WASTE MANIFEST Document No <br /> of 1 Is not required by Federal law <br /> 3 Generator's Name and Mailing Address JOB SITE, CASCO SERVICE STATI A Stele Menilest Document Number <br /> INC <br /> 3450 El carni no Avenue 749 E. Charter Way' 89493281 <br /> Series, CA 95307 Stockton, California s State Generalities w <br /> 4 Generator's Phone(209) 537-0771 <br /> 8 Transporter 1 Company Nam* 8 US EPA ID Number C Slate Transporler's W 003773/81 <br /> H S H Ship Service C npany CAD 0 0 4 7 7 1 1 6 8 D Tranoport*r's Phone 415 543-w-4835 <br /> N <br /> Q7 Transporter 2 Company Name 8 US EPA ID Number E Slate Trsnsporlines ID <br /> S I I I I I I I I I I I F Transporter's Phone <br /> �Q g Designated Facility Name and Site Address 10 US EPA ID Number G Stale Facility's to <br /> H E H Ship Service Coapany CIAI DI 0101 417r.711111 61 8 <br /> 220 China Basin Street K Faciltly's Prone <br /> San Francisco, CA 94107 <br /> y CAD 0 0 4 7 7 1 1 6 8 (415) 543-4835 <br /> 12 Containers 13 Total 14 <br /> 11 US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Ouantity Unit Waste No <br /> tNo I Type WI/Vol <br /> ' G a RES I DUE WASTE O i L TANK P staSe 512 <br /> X E (CALIFORNIA ONLY REaJLAT® WASTE) EPA/other <br /> 3 <br /> N _kL01 1 TI P 01012181 0 <br /> a bRESIDUE ASSOCIATED PIPING <br /> State 513 <br /> S'w i (CALIFORNIA ONLY RECIJLATED WASTE) 01115 C Y 0 0 P EPA/Other <br /> N O <br /> r R c Stale 241 <br /> HAZARDOUS WASTE L I QU I D, N.0.S. ORM-E NA 918 9 G EPA/Other <br /> 0 013 D M 0101 11 6t 5 <br /> '�tr d Stale <br /> Z <br /> W EPA/Other <br /> , <br /> J Additional Deacriptions for Materials Llated Above K Handling Codes for Weston Listed Above <br /> N RMED OUT 280 gallon tank and associated piping East a 01 b 01 <br /> W containing waste oil . Tank inerted with dry ice for <br /> transport. d <br /> a iUEL OIL AND WATER 01 <br /> 15 Special Handling Instructions and Additional Information <br /> Z <br /> J APPFOPR I ATE PFd7TECT I VE CUDTN I NG AND RESPIRATOR. <br /> J <br /> � 18 <br /> 'H J 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 /> 1,IT If I am a large quantity generator,I certly that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> Y9 to be economically practicable and that I have selected the practicable method of trealm 1,storage or disposal currently available to me which minimizes the <br /> } present and future threat to human health and the environment OR it I am a smell an general l ve e s good Leith allorl to minimize my weals <br /> U generation and select the best waste management method that Is available to me d at l can rd <br /> Z <br /> CW7 PrintedlTyped�Name`� Signature Month DayYear <br /> W � VI4If/ (/`r �Lv • '�Y/ 101111021910 <br /> WT 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> Z R <br /> d A Printed/Typed Name Signature k" 101111121 10 <br /> Month Day Year <br /> FREDERI Cx -rn3UNE NEAL " r0+'1 <br /> W O 18 Transporter 2 Acknowledgement of Receipt of Malariala <br /> UT Printed/Typed Name Signature Month Day Year <br /> * E <br /> a 19 Discrepancy Indication Space <br /> !� F <br /> A <br /> C <br /> L <br /> 1 20 Facility Owner or Op for Certification of recelplof hazardous materials covered by this meniT t exce s noted n Its i <br /> I � T <br /> Y Prf 1 Ypo Nama Signature Manch Oe er <br /> ----SVCLI fir- <br /> s 8022 A(1188) Do Not Write Below This Line <br /> ,EPA 8700-22 <br /> Rev g 88)Previous editions are obsolete White TSDF SENDS THIS COPY TO DOHS WITI IIIA 10 DA c <br /> To PO Box 3000, Sacramento, CA <br />