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atare or "ifrurnio—r;nvuonmentai rrorecnon agency is a <br />Form Approvcd OMB No. 2050-0039 (Expires 9.30-99)" � _ �1 dee Inst <br />Please print or type. Form designed for use on elite (12-ptfah) : 1-185— <br />lease <br />C <br />L4 <br />�r <br />r <br />C, <br />V <br />a <br />C <br />C <br />a <br />L <br />C <br />'C <br />L <br />22 <br />3 <br />C, <br />C: <br />ac <br />ac <br />C, <br />c <br />C: <br />CX <br />Ck <br />LLZ <br />LL <br />L <br />LL <br />V. <br />Z <br />C <br />a <br />v: <br />09 <br />Q <br />Z <br />C <br />a <br />z <br />LL <br />a <br />C <br />i <br />U <br />Z <br />w <br />U <br />ae <br />LU <br />w <br />0 <br />U-1 <br />a <br />U <br />r'i <br />- DO NOT WRITE -BELOW THIS LINE. <br />DTSC 80 (l/99) <br />EPA 8700-0-22 Green: TRANSPORTER RETAINS. <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Document, No <br />2. Page I <br />Information in the shaded areas' 1 °§ <br />WASTE MANIFEST <br />CALt�CD02 2.1947 <br />j <br />is not required by Federal law." ' hr <br />of <br />CG�Byng.ols Nra},rp �'Il1 f g Address � L �•1 C' <br />.7 -.L t� rl L'114 :,,i 1. 1 <br />.. <br />A. State Manifest Document Number ?ry *pqp a{q <br />2 14 n 4 <br />DAVE CARLOCK <br />y <br />�f 1. WGA . <br />ST0C1.%TO14 CA 95215 <br />B. State Generator's ID <br />4. Generator's Phone ( {.' �) 4 6 0 " 6 0 +V 1 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserved.] <br />SAF;,R'xr—KLZE.N `' SATEM4S' THC. SCR000075150 <br />D. iransperter's Phone <br />800 669--5340 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID [Reserved.) <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />050144 <br />G. State �Feacili 's ID <br />0 <br />- <br />Ell <br />S:iF:.7 Thi -KL's EEll j SIAM, J()ed F, J, I <br />1t, 4 -) <br />H. Facility's Phone - <br />102ii3i:aRs,�iE10*1�fY RD CAD059494310 <br />SAN CA 95.13 3 <br />800 4 5 -3 358 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number[ <br />12, Containers <br />13. Total <br />Quantity <br />14. UnitNo. <br />Wt/Vol <br />I. Waste Number <br />Type <br />a. NON—RCCA fiAZARDOU WASTE LIQUID <br />State 222 <br />OIL, WATER. SLUDGE( 140T DOT REGULATED) <br />TT <br />� � "`y <br />G <br />EPA/Other <br />G <br />C, <br />� <br />E <br />N <br />b' <br />State <br />E <br />EPA/Other <br />R <br />A <br />T <br />C. <br />State <br />O <br />EPA/Other <br />R <br />d• <br />State <br />r <br />EPA/Other <br />J. Additional Descriptions For Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />Ib. <br />s -z <br />15. Special Handling Instructions and Additional Information <br />MF S T RST# 10170486 6 0002-6933-98 <br />r.14F?GETIC'i RESP 800-468-1760( 24 HR). IF U14DELIVERABLE RETURN TO GENERA'T'OR. <br />"K CORP AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY. <br />n m 7 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of thisconsignment are fully and accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />I <br />. I <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 />practicable and that I have selected the method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />practicable <br />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 />available to me and that I can afford. �? <br />Printed/Typed Name / <br />Signature a <br />Month Day. Year. <br />14 11: <br />T <br />17. Transporter 1 Acknowledgement of Recei t of Materials — !.' .✓ <br />A <br />Printed/Typed ed Nam <br />me ; yP e',•',.,g <br />Si natur <br />� �� <br />nta ,}'ear _ <br />y / of <br />S <br />P <br />g <br />1 8. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />IF <br />A <br />C <br />l <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered 6y this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name _ !– <br />Signature / <br />Month Day Yeor. <br />- DO NOT WRITE -BELOW THIS LINE. <br />DTSC 80 (l/99) <br />EPA 8700-0-22 Green: TRANSPORTER RETAINS. <br />