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CORGE W. LOWRY, IN MODIFIED MANIFEST <br /> PETROLEUM PRODUCTS - <br /> EPA # CAR 000 047 019 44.23 9 <br /> P.O. Box 176 CA TRANSPORTER REGISTRATION NO.3844 <br /> Salida, California 95366 <br /> (209( 545-0791 Manifest # 'S/ .1G/ <br /> GENERATOR p REC CLING FACILITY <br /> 1A A <br /> Phone # Quet) t 2Lf Phone # C7 <br /> EPA # (;97o6f5/ 26 EPA # All/ t141-K <br /> DRIVER PRICE PON DATE <br /> r• <br /> GAL. OF USED LUBRICATING OIL <br /> GAL. OF USED INDUSTRIAL OIL <br /> GAL. OF OILY WATER OR PURGE WATER :1;4 1 [ C <br /> GAL. OF USED AUTOMOTIVE ANTIFREEZE <br /> DRUMS OF USED OIL FILTERS 5 <br /> CHLORINE CONTAMINATION: <br /> SzoT - oho - 01—� <br /> ;PLEASE PAY FROM THIS INVOICE. MAKE CHECK PAYABLE TO GEORGE W. LOWRY, INC. <br /> Generator Signature c.✓ - <br /> H <br /> W <br /> K <br /> Is. petal H dh, t.0 : and Adde I <br /> Q -K 4'Is, <br /> 1� °X'�.4 is y t y,Y� :-.,c'> C"'•r, ���. L r ,=r/ <br /> Z ,1.Hhr <br /> w <br /> ,j.l.lilr" F�(frh' 7�: 5` 7- cfuc.l <br /> 16. GENERATOR'S CERTIFICATIO : I herebydeclore that the contents of this consignent are fully and accurably described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and ore m all respects in proper condition for transport bymhighway according a applicable international and nationol government regulations. <br /> J If I am a large quanii generator,I certify that I have a program in place Io reduce the volume and toxicity of waste generated to the degree I have determined to be economical <br /> h <br /> a exec icoble and that I hhave selected the practicable melhod 3 treatment,storage,or disposal currently avoilable to me which minimizes the present and Future threat to humhn heel <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 /> available to me and that I can afford. <br /> O <br /> y Printed/Typed Nd . Signature Month Day Year <br /> V <br /> 19 1 17. Transporter 1 Acknowledgement of Recei t of Materials <br /> MW Al Printed/typed Name signature Month Day Year <br /> W P 1 E,. % l f / c{ 9 <br /> O8 18. Trane oiler 2 Acknowled em nt of Recei t o Materials ' <br /> IPrinted/Typed Name Signature V Month Day Year <br /> w E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z r <br /> — A <br /> C <br /> 1 20. Facility Owner or Operator Certification of recei t of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Isdated/Typed Nam. Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (I/99) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />