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State of�California—EnViranmentol Protection Agency �` [ <br /> Formoproved OMB No 2050-00P.9 {Expires 9 30 991 See Instructions on back of Page 6 Department of Toxic Substances Control <br /> Plaae or type Form designe for use on efrte(i 2 pitch)typewriter Sacramento,California <br /> F3 -34� <br /> NIFORM HAZARDOUS I Generator s US EPA ID No Manifest Document No 2 Page 1 information in the shaded areas <br /> WASTE MANIFEST C L {j 0 c} {)� is not required by Federal law <br /> I of , <br /> I Generator same and Mailing Address A State Manifest Document Number l �r� <br /> DARPETRG, INC. 1, 1 <br /> '.:L CAMINO CTRES, CA. 95307 R Stole Generator's ID <br /> � k <br /> A Genarator s Phone f)()q <br /> )537_L,77, d` <br /> x <br /> (V 5 Transporter 1 Company Name 6 US EPA ID Number C State Transporter s ID <br /> u7 <br /> as <br /> 0 I IELLEY' S —717V. .;—.,?V. its;". D Trci.parter'sPhone i <br /> 0 <br /> 00 7 Transporter 2 Company Name 8 US EPA ID Number nsp�r tD 1 <br /> I J <br /> QF Transporter'a Phone s t <br /> V 9 Designated Facih Name and Site Address 10 US EPA ID Number G State Facility's ID <br /> ;SAY:; D 01L 11, 1,giC CA]P0P§8#8R32j <br /> 210 ^1ON�.'I:�AL ST. CADOOSS38222 H facility sPhone x I a i <br /> `-' SAilr.:A CRUZ, CA. 95060 1 � I I I I I I I I 1 1 40$ 427-3773 <br /> 12 Containers 13 Total 14 Unit <br /> 1 I US DOT Description(including Proper Shipping Name Hazard Class and IQ Nvmberl No Type Quantity wt/vol I Waste Number cj <br />�.= a -1T0N—RCRA AAZARDOUS WASTE LIQUID 1 `j G State x9'" <br /> G (WATER AAD US= OIL) � EP.�'i 00-, r4 <br /> F t_ Y r if Tr,r <br /> N state _ <br /> L <br /> co E <br /> R EPA/Other <br /> v n ; <br /> ._ ,I� l r Ta <br /> A State , v 'r I <br /> O T <br /> '0 EPA/Oth*T ". <br /> R <br /> Iw d <br /> Zrte* tx T � <br /> yr..y v-r'r'S� +7`Cs" �t rz�"' A c �` ? <br /> 1` Additionpi Qescrrpharn gr-MarialsJtsted AboYe f r 4 y_x+, r is i• 'a- i ,T, 1C;yNandhng1Codes for Wastes Listed A6ore} <br /> 4 - 'cam �yyy�. aY�y r , �s ,r r� tt�yvr �rtp <br /> .���+�"'- 1:.♦ C[� i��- ��f�� "`�� k ��l' ,,� � ry F4 �y�� �,�. �s' 1 �� <br /> t "t +.. <br /> 4 <br /> Ud.1 EaE T aA^t'F:" �� µ 0 1 'f'-l�l 'i <br /> W t�,f +. 3rtw 7 c T r„iJ.;�. ,s�p.+s ti i I" kb pt" ,�•` S <br /> J 'x. � '7ak j3�.y �>„,.rv^�5^"� '9 ti 1+�a�'¢ it' 4 ��J .0 �..i• ,y,, <br /> Ca�-t`''.ti. <br /> O15 Special Handling lnstructions and Additional Information <br /> QUSE STANDARD SAFETY PRECAUTION AND STAL4DARD PPE PTCK__D UP <br /> Z 24 HOUR FACILITY (4088) 427-3773 AT: <br /> u, <br /> = 224 HOUR GE3ERATOR ( 209 ) 576-8500 749 E. CHARTEAWAY 7V_ <br /> 16 GENERATOR'S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper ship ing name and are classified packed <br /> Umarked and labeled and are in all respects in proper condition for transport by highway according to applicable international and nationo government regulations <br /> J <br /> -� If I am a large quanhry generator I certify that I havecprogram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> d practicable and that I hhave selected the practicable method of treatmentstore disposal currently available to me which minimizes the present and future threat to human health t <br /> in <br /> and the environment OR if I am o small quantity generator I have mad good fa h effort to minimize my wast tion and select the best waste management method that is I <br /> u available to me and that I can offord <br />'OTyped N Signatu Month Day Year <br /> z V4vae �ss� T U ; <br /> W T <br /> 17 Transporter l AkAnowledgement of Receipt of Materials Ar <br /> LU <br /> :E <br /> A Printed/Typr,12Acknowli <br /> �ell4e, Signature Month Day Year <br /> LU $ f <br /> LU <br /> ii J - <br /> 0 1 B Trans ement of R ei t of Materials <br /> TPrinted/Typed Name Signature Mont!1I Day Year <br /> V) E <br /> Q R <br />'IJ <br /> 19 Discrepancy Indication Space <br /> � F <br /> A <br /> C <br /> I 20 Fonh Owner r D erotor Certification of receipt of hazardous materials covered b thi onifest except as noted in Item 19 <br /> Panted/Typed me /' Signature /' Month Day Year <br /> 1710 � /I / <br /> qlt DO NOT WRITE BELOW THIS LINE. <br /> Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> DTSC 11022A 14/971 (Generators who submit hazardous waste for transport out of state <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days) <br />