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Slate of Californio—Emironmentof Protection A�eney <br /> Form Approved OMB No.2050-0039(Expires x•30.95( See Instructions on back page 6, Department of Toxic Substances Co <br /> Pleose print or type. form designed for use on elite(12-pi rihr. �,j Sacramento,SubstCalifoances <br /> nia <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST is not required by Federal low. <br /> CAL0000102417 1 6 14 10 16 oft <br /> 3. Gewasar's Name and Mailing Address <br /> MCMi LL SF1'ELL STATION , <br /> c 2065 COL:`Y, Ems, CA 95326 e � �� <br /> 4. Generator's Phone(209 ) 838-7902 ,9 a <br /> N 5. Transporter 1 Company Name <br /> h 6. US EPA ID Number tID ryl <br /> o l3ui� CAL, vIL { :.'{Za�j b6 e—c692 <br /> o CAD9F324I72S5 � #o!q!» , <br /> : rte ' <br /> 7. Transporter 2 Company Name 8. US EPA ID Number s <br /> 7iartsperler{'g.,b F 4. <br /> w.k'`'. ?--'; r.�.;•' 4 f7. <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> �Z INDUSTRIAL SERVICE OIL CO c�t�' <br /> O 1700 S. SLM ST. <br /> :OJ I,SAtx,UAZ-, CA90023 ICAD099452708 <br /> ~U 11. US DOT Description f including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers/ 13. Total4 14. Unit <br /> v No. Quantity Wt/Yd I WmN <br /> Z o. T ' <br /> p= [r'(Y-4—E RA HAZARLMS WASTE IXXIC stat. .' <br /> Ty N E( ✓4ATEF<.S SLUDGE) <br /> o <br /> N b. <br /> coo E 'g <br /> C4 A FPA/0 <br /> c.Go 0 <br /> Slaty s. n; <br /> . a <br /> R <br /> Uj <br /> d. <br /> Z � 1i , <br /> a <br /> W <br /> LU <br /> cm � 1t <br /> Z MR11 K <br /> 0 15. Special Handling Instructions and Additional Information <br /> ;WPROPRI.ATE1 PROT1=n% ^LOrhM& JVP SITE: MCLCAML SKUL STATION <br /> Z 'ENERc—aa- jCY Cl3tiTACT: (209)541-9145" 1360 ESCALCN AVE. <br /> LU <br /> SAF E.R.G. 171 kZCUa-4, CA 95320 <br /> Q16. ORATOR'S CUMICATION: I hereby decksre that the contents of this consignment are fully and accurately described above by proper shipping name and on classified,packed, <br /> V marked,and labeled,and aro in all respects in proper condition for transport by highway according toapplicable international and national government regulations. <br /> If I am a large quantiy generator,I certify that I haw a program in place to reduce the volume and toxicityof waste generated to the degree I have determined to be economical <br /> practicable and that I have selected the cable method of treatment,s <br /> practicable storage,or disposal currently available to me which minimizes the present and Future threat ro human heal <br /> aced the msvironment;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 /> 0 ovaiksble to me and that I can afford.-' <br /> VPrinted Name ' Sigrwture- Month payio <br /> W '' A Y' ., <br /> a17. Transporter 1 Acknowledgement of Rec ' t of Moserio <br /> onceR <br /> N Printed/Typed J , _ Signature 4"L3 <br /> —ypW = jGjIC//J rG7' <br /> P <br /> LA_ B 18. Transporter 2 Acknowledgement of Receipt of Mot ials <br /> 0 T Printed/Typed Name Signature Month Day Year <br /> N <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> LU <br /> E <br /> Z F <br /> A <br /> C <br /> 1 <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous aterials cover is mofil s xc t as noted in Item 19. <br /> Y /T % �C � Signotu ' (� - `^^\ Month Day Year <br /> o 3 ail <br /> DO NOT WRITE FLOW HIS LINE. <br /> DTSC 8022A(4/97) <br /> EPA 8700-22 Green: TRANSPORTER RETAINS <br />