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Environmental Protection Agency <br /> OMB No.2050-0039(Expires 9.30,94) S@@ IRS?rUCFIOi1S Oft back of page`6. - Department of Toxic Sobstoncn C" <br /> s or type. Form designed far use'on elite(12-pitch)typewriter. _ Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas 'r� <br /> is no!required by Federal low. <br /> WASTE MANIFEST C A L 9131010161 3 1 8 fi 5 0 2 0 2 of 1 <br /> 3. Generator's Nome and Mailing Address A. State Manifest Document Numb r <br /> ULTRAMAR, INC. "" �+r� ° <br /> ,n 525 West Third Street Hanford CA. 93230 3 V G <br /> Street, B. State Generator's ID d^ a <br /> N 4. Generator's Phone583-3347 <br /> (209) 583 -3347 H• Y H <br /> 00 <br /> 5. Transporter 1 Company Name. b. US EPA ID Number G. State Transporter s 7p <br /> �;�,6009r3�. a <br /> H & H Ship 3fsrrvi a Company CAD 0 0: 4 7 7 :: .� 6 $ p-«F�ansponer'sPh'' <br /> 7. Transporter 2 Company Name 8:--US EPA ID Number '1. State Tronsporter's ID v <br /> ULj F. .Ironsporlers Phone w <br /> c. <br /> r Q 9. Designated'Facility Nome and Site Address 10. US EPA ID Number Cz.State Facility's ID t3j <br />�,,.. H & H- SHIP SERVICE COMPANY CAD 0 0 4 7 7 %$; <br /> • ��.. <br /> rl 0 220 CHINA BASIN/TERRY FRANCOIS H. Pa�lli'} phone <br /> SAN 'FRANCISCO, CA. CADO047711 415) 543-4835 <br /> .•. ';�_, r•j_s!1V :.r,; <br /> 1618 <br /> \,f V Cota <br /> Z 17. US DOT Description(including proper Shipping Name,Hazard Class,and ID Numbed 12. iners 13. Total 14. Unit <br /> Y <br /> No. Type Quantity Wt/Vol f. Waste,I+htm�iersr �. <br /> t- kESIDUE GASOLINE WANK :• , r.Y ." <br /> 3 G NON-RCRA HAZARDOUS WASTE SOLID 0 0 1 T P 0 9 0 0 0 Pp /oitiey .v <br /> CD <br /> 00 E <br /> Liv / <br /> R ` EP-. . <br /> v <br /> A ��y • '-is <br /> a T C Srofeg< t� <br /> C9 0 <br /> R EPA/Otlsan n - Jnr <br /> Zd, 51dfe'' ' �fFri' <br /> LLs , <br /> V EPA%Ot}s , <br /> J, Ad�honol DescriptlatA iox Most 606 listed Above <br /> X. Handling Codes for Wastes[fisted Above ` r <br /> E "lt $'.rEl0Q $aN #tfs ,I aTt1 to t nt l itsin 01, <br /> fa >lx�.. 11f�1Cf�i� � h ace or s7fff <br /> ,> Yr. <br /> ay <br /> a ROS <br /> P ; <br /> Z <br /> o 15. Special Handling Instructions and Additional Information { <br /> , <br /> a JOB #15484 JOB SITE: BEACON STATION, #502 <br /> Z 24 Hr. Emergency Contact: H & H #(415) 543-4835 35 North Cherokee <br /> = APPROPRIATE PROTECTIVE CLOTHING AND RESPIRATOR Lodi, California <br /> w <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 Ckxsified, <br /> packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regvlaftonL <br /> V <br /> ,i 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 <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and(uNre <br /> 4 threat to human health and the environment; OR, if 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> N waste management method that is available to me and that I can afford. <br /> O <br /> PriWojWyped me l \+\ ! Si - Month Day <br /> Year <br /> >_ V ♦ i \� 0 2 2 8 9 7 <br /> V T 17. Transporter 1 Acknowled ement of Rec t of Materials <br /> Uj It r OMo 2 2 Doy9 9Uar.'s <br /> Ur N Printad ,t,aY PETRUCCI 5ignaiur <br /> 0:: s _ <br /> W P <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> ts.t T Printed/Typed Name Signature Month Day YeW• <br /> LL E <br /> 0 R <br /> Lu 19. Discrepancy Indication Space <br /> u7 <br /> Q F <br /> V A <br /> ZI <br /> _ - <br /> 20. FacilityCOwner or Operator Certification of receipt of hazardous materials covered 6 this manifest except as noted in Item 19. <br /> Month Day <br /> Printed/Typo Name Signature � <br /> DO NOT WRITE BELOW THIS LINE. �� <br /> 0—Y <br /> � <br /> Y <br /> Yeilow: TSDF SENDS TH15 e0PY TO GENERATOR WITHIN 3R DAY Taft, I <br /> DTSC 8022A (9/93) (Generators who submit hazardous w ptnal sendato C erilhi 30 <br /> EPA 8700-22 produce completed copy of this copy s <br />