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late of California—Environmental Protection Agency arm Approv MB No. 2050-0039 (Ezpires 9-30-99) l designed fo ft f12 See Instructions on back of f 6. Department of Toxic Substances Central Sacramento, California eos� r or ype. Form ruse on e fit. -P,Rry ry,-•� „ 1. Gauera 'r'i US EPA ID No. Manifest Document No. 2. Page 1 Information is the shaded areas • UNIFORM HAZARDOUS /'t / • j of required by Federal law. WASTE MANIFEST A )j) '`f v of J .s v A. State Manifest Document Number w 3. Generator 's Name and Mailing Address SIA COUNTRY _233540 6 4 i515 N MAIN ST B. State Generator', ID ry�v�I TfT�f�s CA 95336-3243 d.- e'naralor s 4hone ( 1 °y _.' ) 0 . 5. Transporter 1 Company Nome 6. US EPA ID Number C. Stale Transporter's ID [Reserved.) SAFETY—KLEEN SYSTEMS, INC ^' OT)0 J"0` 3 D. Trm.porter's Phone E. Stole Transparter's ID [Reserve 7. Transporler_2 Company Name 8, U5 EPA ID Number F. Transporter's Phone 10. US EPA ID Number G. State facility's ID 9. Designated FacilityNome and Site Address A G Q 4 5 7 000760 SAFETY—KLEEN SYSTEMS, INC• C OL 0, 4 17 H. FadBys Phone 6000 88TH STREET o T _dR a C 12. Containers 13. Total 14. Unit 1 I. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) No. T e Quantity WI/Vol L Waste Number Slate HAZARDOUS WASTE, LI UID, N. C. S. / G EPA/Other G 9 NA3082 PG III (U039) ERG#].71) F a E n r r o r State i N 6. E EPA/Other A State 0 EPA/Other R Stale d. i i EPA/Other 7 I K. Handling Codes far Wastes Listed Above J. Additional Descriptions for Materials Listed Above 6. 14. u d, e t 15. Special Handling Instructions and Additional Information MFST R/T#104995079 0000-3703-99 EMERGENCY RESP 800-468-1760(24 HR). IF UNDELIVERABLE RETURN TO GENERATOR, Z SK CORP AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY. z 16. GENERATOR'S CERTIFICATION: I hereby declare that the conten s oFfhis cons�gnmen) ore fully on a<curols yy described above by propel shipping name and are classified, packed, Jmarked, and labeled, and are in all respects in proper condition For transport y highway according to applicable international and notional gavernmem regulations. ` If I ama large quanta generator, 1 certify that I hove a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically i practicable and that I have selected the pmclic°61e method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health 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 a' available to me and that I con afford. Si Lure . ' % - Month,ear( Printed/Typed Name /^ 0" --� Z �1 f Is,EDipancy ortdr I Acknowledgement f Receipt p of Materials Ur w��Name !; Siyp tore ortar 2 Acknyped Name Signature Month Day Year Uepancy Indication Space — A j n 20. F.cilityO,I ,Ii of hazardous materials co erd'6 ,3kis mbnifest xce t o noted i em N,T Printed/Typed Name Sig nature - �\ A-'!� ,7 MontfJ i Y-pq� -Yeo y ' // J)' :DO NOT WRITE- BELOW THIS LINE. �-- Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. (Generators who submit hazardous waste for transport out -of -stole, DISC 8022A (1/99). produce completed copy of this copy and send to DTSC within 30 days.) EPA B700-22 :DO NOT WRITE- BELOW THIS LINE. �-- Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. (Generators who submit hazardous waste for transport out -of -stole, DISC 8022A (1/99). produce completed copy of this copy and send to DTSC within 30 days.) EPA B700-22