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Ston of California—Envirottmantd Proteclion Agency <br /> Form Approved OMR No,2150-0039{Expires 9 30-991 See Instructions on back of page 6.. Department of Taxi<Sobstonces Control <br /> Please print Or type form drsigned for use on 64te()2-pitch)typr—rter Svcromsnto Cdifarsio <br /> UNIFORM HAZARDOUS 1 Generotw's US EPA tD No — Manifest Document No 2 Page I Informoton in+he'hold ureas <br /> is not required by Federal law <br /> WASTE MANIFEST of <br /> —. f-- <br /> 3 Gvrutoe.Name and Mailing Add— A Slate Manifest Document Number 248 6 4 3 0 4 <br /> ne <br /> 0'3A Pairoleoa Corporation <br /> 903 ttaAcho Coaclo Blvd. <br /> Hewbssry Part, CA 91320-1716 5 Stu*Oenerotors 16 <br /> e Genwaror's Phone{ f8(1S� 214-92GO _ <br /> S Trensperter 1 Company Nome 6 US EPA ID Number C stale Transportef s ID(Reserved I <br /> aO B tllhir¢ 3Avirotvtantal 3¢rvice9, Tac- <br /> 8D Transporter's Phone <br /> R 7 X9491 <br /> 0 46�?2 0 0 <br /> 0 <br /> _ 7 Tronsponer 2 Comparry Nome JJ/A1� B US EPA 10 Number; E Stale Tronsporter's ID(Reserved f <br /> ��1-� 1.=JLI Cii✓I�IZi x�I'� I�( 3 F transporters Phone ��� /lP. •� �.� <br /> 9 Designated Facility ome and Sit*Address 1 yL 10 US EPAI ID INumbe, a•n G Stole Fac:fity's ID <br /> '04 U3 ecology, tdevada Oparatioan <br /> C2 Highway 95, 11 xUall 9. of Beatty H for litt7s Phone <br /> �3 Beatty. HV 890(13 , <br /> MaJ N V T 3 3 4 0 1 0 0 0 0 (775) 553-2203 r- <br /> d'up l' 8 ai^n Shipping 1 12. Containers 13 Totd 14 Unit <br /> I 1 US DOT Descn Iwn n<IuJbr Pr Shi n Name Hazard Clam and ID Number i <br /> No. type Quantity Wt/Vol I. Waste Number <br /> Nz!E aSolids Containing Flammable Liquid, N_0.9 4..1 stare <br /> 3 G UN3175, PG II (Gasoline) O D t{ P EPA/Other <br /> E b 1rEXEMPT <br /> o N sat. <br /> OD E <br /> .7 R EPA/Other <br /> v A -- -- LL <br /> o T <br /> co O <br /> — R EPA/Other <br /> Torr 4105 Aw10; <br /> w d Slate <br /> z i <br /> W <br /> V EPA/Other <br /> w _ <br /> z J. Additional Descriptions for Materials Listed Above K Handling Codes for Wastes Listed Abve <br /> g o <br /> Z ERG$133 a b <br /> w RCRA Exempt under 261..5 401FR <br /> Debris with Gasoline ° d <br /> z 4� .G 13 - <br /> 0 15 Special Haadfing Instructions and Additional Information <br /> 24-HOUR EHBRGENCY PHONE: 5E3I: 118990 <br /> c( USA 3696 <br /> Z WEAR ALL APPROPRIATE 949-460•-5200 (M-F HAM-5PM)Uj 2848 W 1Cettlem2n Lane <br /> PER30NAL PROTECTIVE EQUIPMENT 949-699-2706 (24-HOURS) Lodi CA 9529 <br /> 16 GENERATOR'S CERTIFICATION: I hereby dedore thot the contents of this torso'' nment are(oily and acuraWy described obrne 6y proper stripping name and are clarified packed. <br /> Q marbled and labeled.and ore in all respects in proper condition for transport ky highway according to applicoble inlernational and notionol government regubtioro <br /> v <br /> 1 If 1 om a forge quoriti gtnerator.I remit[/that I have a program in plata to reduce the•rolvme and toxitlty,of waste generated to the degree 1 hove determined to be econamicol�y <br /> N practicable and that I bave selett•d the pracfica6la method of treatment,storoge,or d'oposal currently available to me which minimizes the present and future Ihreot to human heohh <br /> and the savironm ret;OR,if I am o small gvontiiy generator.I hove made a good faith effort to minimi y wrote generation and-led the best wosto reanogement method that,, <br /> 0 ovaifable to me and that I con offord <br /> - Printed/Typed Name Srgnvlure Mont Oa� Year _ <br /> V Larry Moothart oa Behalf o1 Canerator 6 <br /> Z <br /> W T 17. Trans ter 1 Acknowledgement of Racei t of Materialsit <br /> _ <br /> w E Printed/Typed Na $igno a c Mont Day Year _ <br /> N <br /> W P f Q <br /> aL p 18. Tran per 2 Acknowied ent of Recce r of Materials <br /> O et hinted/TYM m. <br /> f Signatvrs f D Ye <br /> W E C2� R <br /> Q _ i <br /> V 19 Discrepa motion Spore <br /> ? A FAC#._�,�(s' <br /> II# /a3��o <br /> 20. Focil,tyOwner or O roror Gnificai,on of recei of hazardous materials covered b dsis marsifest exce t w paled in_Item 19. <br /> T Printed/Typed Ncme Signalure Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE., <br /> white. fSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> EPA 87700-22 <br /> DISC 00 {1/991 To- P() Box 3000 Sacromento.CA 95812 <br /> — <br />