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_.._.- <br /> �° CAORGE W. LOWRY, IN MODIFIED MANIFEST <br /> PETROLEUM PRODUCTS <br /> EPA#CAR 000 047 019 <br /> P.O. Box 176 CA TRANSPORTER REGISTRATION NO.3844 <br /> Salida, California 95368 <br /> (209) 545-0791 Manifest# "57X/3/ Sl <br /> GENERATOR RECCLING FACILITY., <br /> E 2 L " <br /> Phone # i el l' G L! Phone # S 71- qcv i1 <br /> EPA # f f <..:> ; +r5 6 EPA # <br /> DRIVER PRICE PO# DATE �7 <br /> S o �7 r <br /> GAL. OF USED LUBRICATING OIL <br /> GAL. OF USED INDUSTRIAL OIL <br /> GAL. OF OILY WATER OR PURGE WATER <br /> GAL. OF USED AUTOMOTIVE ANTIFREEZE <br /> DRUMS OF USED OIL FILTERS 1 S <br /> CHLORINE CONTAMINATION: <br /> SZos - 0/0 - O/-/ <br /> 41L- <br /> ,,PLEASE PAY FROM THIS INVOICE. MAKE CHECK PAYABLE TO GEORGE W. LOWRY, INC. <br /> r - <br /> Generator Signature <br /> CL <br /> N C <br /> W <br /> C. d. <br /> Q <br /> 0 15. Special Handling Irrtruc,tf)'ons and Additional 1 formation <br /> Z �Il; til Ger ;; r � . :tfl �fi f_. <br /> LU <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping 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 national government regulations. <br /> If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <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 humbn health <br /> N and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> rY available to me and that I can afford. <br /> OPrinted/Typed Najne Signature (Month Day Year <br /> w T 17. Transporter 1 Acknowledgement of Recei t of Materials <br /> � NS <br /> R Month Day Year <br /> LU A Printed/Typed Name Signature <br /> LU <br /> UL 018. Transporter 2 Acknowled ement of Recei t o Materials <br /> 0 R Printed/Typed Name Signature Month Day Year <br /> T <br /> w E <br /> N R <br /> Q <br /> U F 19. Discrepancy Indication Space <br /> Z A <br /> — C <br /> I <br /> L <br /> f 20. Facili Owner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />