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Slate of California—Environmental Protection Agency <br /> Form Approved OMB Nor 2030-0039(Expires 9-3099) See Instructions On baCstesis,Page 6. Department of Toxic Substances Cann <br /> Pisan print or type. Form designed for use on elin(12 prlsr/jpewriler. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID re <br /> No. Manifest Document No. 2. Page 1 Information in the shaded..as <br /> is not required by Federal law. <br /> WASTE MANIFEST 1 C C 1 I I q 1 I 3 121 1 1 3 4 3 of 1 <br /> 3. Gene101B"same and Mailing Address <br /> Rei,�t1 co-2 wAtti <br /> FLUID MANUFACTURING <br /> h 1010 E. LOD I AVE. , LOD I , CA 95240 <br /> V) <br /> /. Generator's Phone I �r=i 334-e,l•�^� <br /> r S. Transporter I Company Nome 6. US EPA ID Number <br /> °ur)° NOR CAL OIL C AD 9 32 4 17 2 5� <br /> 0 <br /> 0 <br /> a? 7. Transports,2 Company Name 8. US EPA ID Number <br /> 9, Designated Facility Nome and Site Address 10. US EPA ID Number <br /> ;'d HAYSIDE OIL II . INC. <br /> _10 ENCINAL ST. ; <br /> —10CRUZ . CA 950FCt D + i y. <br /> SANTA <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and 1D Num6ar) No Conloieers 13. Total 14. nil <br /> "�U No. —Typs Quantity WI/Vol <br /> Oz o. <br /> p NON-RCRA HAZARDOUS WASTE L.IGUIL <br /> 3 G ( WATER) <br /> ?1 T T G <br /> E <br /> N Is. <br /> co E <br /> 4 R <br /> v <br /> T a <br /> S T <br /> m O <br /> R <br /> d. <br /> `Lw <br /> U <br /> w <br /> Z <br /> Z <br /> 2 <br /> N <br /> w <br /> K <br /> Q <br /> 0 15. Special Handling Instructions and Additional Information <br /> a APPROPRIATE PROTECTIVE CLOTHING <br /> Z "EMERGENCY CONTACT: (209)541-9145" <br /> SEE E. R.G. 171 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that theconIsms of this consignment or.fully and occwately described above by proper shipping name and are do"ifid,p.ck.d, <br /> Vmarked,and labeled,and ore in all respects in proper condition far transport by highway according to applicable international and national government regulations. <br /> If I asn o large quantity generator,I certify rhos 1 have a program in place to reduce the volume and toxicity of wash generated to the degree I have determined to be economicallyy <br /> Npracticable and that I have selected the practicable method a treatment,storage,or disposal wrrendy omilo6b to me which minimizes the present and future threat to human h.= <br /> and the environment;OR,if I am o 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 /> Oavailable to out and that I can afford. <br /> r Prinld/Tyi d Nme Signal Month Day Year <br /> Z 1/'-, <br /> /rt .Es <br /> 16 <br /> T1 . T for 1 Acknowle ement of Recei t of Materials <br /> A PdntedRypd Nome Signature Month Day Year <br /> y R <br /> 0 ; 18. Trona tsr 2 Aeknewl ement of ecsi t o Materials <br /> Val T Pr..W/Typd Name Signature Monde Day Your <br /> V [ <br /> R <br /> 19. Discrepancy Indication Space <br /> Z E <br /> — A <br /> C <br /> 1 <br /> L <br /> 1 20. Facility Owner or Operator Codification of receipt of hazardoes materials covered by this manifestexca t as noted in Item 19. <br /> T Prinsid/Typed N ^ Signature �'� . Month Day Year <br /> Y o 7 — <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 0022A 14/97) ( Green: TRANSPORTER RETAINS <br /> EPA 8700-22 <br />