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State of Californio—Environmental Protection Agency <br /> arm Approved"OM9 No.2050-0039(Expires 9-30-99) See Instructions on back Of page 6. Department of Toxic Sv6stances Control <br /> or type.-.Form designed for use on elite f?2-pitch)Nr'`' er. Sacramento,Colifornia <br /> UNIFORM HAZARDOUS 1\ gyrator's US EPA ID No. Manifest Document No�� 2, Poge 1 Information in the shaded areas <br /> WASTE MANIFEST ' A is not required by Federal Caw. <br /> 3. Generator's Name and Mailing Address <br /> T-� A. Slate Manifest Document Number <br /> 2379362-0.1 <br /> rl�[. 1�IL�a <br /> 0 � 8.State Generator's ID <br /> A. Generator's Phone W" 1 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> h <br /> AME IiaCAN i.Li w"fir :�_ o as yi i r :r ,: �t 5 0 <br /> z a .} 3 D. Transporters Phone <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> QF. Transporle,r Phone > <br /> 9 si f' Rt m an f s" 10. U$EPA ID Number G: $tare act r s D <br /> 5,300 OI AO,'; ROAD <br /> � H. Facility's Phone <br /> y y 9 <br /> 0 RIVE ilAN , CA J13VI`7 C G 01 0 0 F 9 4 f C. <br /> 12. Containers 13. Total 14. Unit <br /> 11, US DOT Description(including <br /> ,Proper <br /> lShipping <br /> 7Name, <br /> �,Hazard Class, <br /> tand <br /> �ID Number) <br /> s y <br /> No. Type Quantity WI/Vol ,A..Waite'NumberR <br /> o. 1''3�.If';t-�3LiRA f�a A.F.l'•li'4s,�a.+U Wi�k.:TE i..IGd01D <br /> late � - ��5- <br /> ~ <br /> OILY WATER ) 0, 0 1 1 T r'` � EPA/Other <br /> G { / <br /> Nb. ° ` :+✓ State... <br /> co <br /> I co E -tPA/Other <br /> T c, -State - - <br /> ao O <br /> R EPA/Other. , <br /> d. Stale <br /> V EPA/Other <br /> J:'Additional Descriplions for MaterialsrListed Above K. Handling Codes for Wastes Listed Above . <br /> b. <br /> -OILY WAT <br /> V7 _ - <br /> . . <br /> 15. Special � ' <br /> p al Handling instructions and Additional information <br /> Q f l,0VE <br /> 16. GENERATOR'S CERTIFICATION: I hereby decldre that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and not; <br /> government regulations. <br /> if I am a large uantiy generator,I cartify that I have a program in place to reduce the volume and toxicity of waste generated to the I have determined to be economicall <br /> qy <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently avoilable to me which minimizes the present and future threat to human health <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 /> avadab{e to me and that I can afford. <br /> Printed/Typed Name f 1 Signature 1 �rMonth I/Day <br /> Year <br /> LU T 17. Transporter 1 Acknowledgement of_Roceipt of Materials <br /> A Printed/Typed Name S Signature Month Day Year , <br /> 018. Transporter 2 Acknowledgement of Recei t of Materials <br /> 0 T Printed/Typed Name Signature Month Day Year <br /> LU E <br /> R <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 [ <br /> L <br /> f 20. Facili Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as nosed in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> ' DO NOT WRITE BELOW THIS LINE. <br /> ITSC 8022A{1/991 Yellow: GENERATOR RETAINS <br /> PA 8700-22 '• <br />