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t.r"°�•. ;,rmla-Health and Wella l . - >; Department of Health Services <br /> ^1°'"d OMB Na.2050-003 FJ res 9,30.91) See Instructions on bac f page 6. <br /> ` ,Jae pint a type. Form for use on elite(12-pitt*�- ewrlfer). -.00 Toxic Substances Control Program <br /> Sacramento.California <br /> UNIFORM HAZARDOUS 1.Generator's US EPA ID No. Manifest; ant f .� Page 1 Information In the shaded areas <br /> ATE MANIFEST A t 0 10 10 10 14 I , l c 1 4 I 1121 Ca/1/ 17 Of is not required by Federal law. <br /> knwadlofs <br /> or' tVame and Magi Address " ewes. ocumenNymr0ERFRISSME( STDAE #i32 �Ptone< )6 - FRENONT CA 94531 °� "e'8500 <br /> ter 1 Compary Name f 6.US EPA ID Number i t t t <br /> (,GA C SYote TtansppftetslD �.:' �: <br /> spprter's <br /> 7.Transporter 2 Comporry Name I I I I yl 1 I I 1 TrpnPTonewit 144 <br /> 8.US EPA ID Number I / •� £Strife TnrspoAeYs ID <br /> r, <br /> V.Designated Facility Nome and Site Address 10.US EPA ID Number <br /> ggSON OIL Co. <br /> 4� ytE PCCR� BLVD A D 0 4 3 ? 6 0 1 8Go ? tlFocrysPhorQ 1 t -T 1T <br /> AE VO 1 Y 96Q ' <br /> 11.115 DOT 12.Containers 13.Tota 14 Unf <br /> Descrlpfbn Oncluding Proper Shipping Name.Hawrd Class,and ID Number) No. T Quant' Wt/Vol t Wane Numtiet <br /> a.oMittASJA E I , r.A.S. State <br /> �g E \ (RAT H WITH L SS TU It IIASOLINE) n 1 `f �f 3 <br /> 1-10 N b., <br /> E s7ols <br /> W J <br /> �..+V T <br /> C. <br /> 1%0 z O \ Sure. Ams <br /> Li <br /> CIO <br /> �d .. srote <br /> N <br /> .. F serlRtross tdkMoterrals ed.Abare' ' . K Hor)dingCodes;Tor Wastes lifted Above <br /> SSS666 I I <br /> ..T.f:X .s.. <br /> LU <br /> :.. <br /> � t <br /> U 15.Special Haring kntructioro and Additional Information <br /> h BETIMES, OOOOLES 5 APPROPRIATE PERSONAL PROTECTIVE EQUIPMENTE4 <br /> O <br /> h EHERQENCY CONTACT- RICH BARL011--510-659-0404 J�s � <br /> w <br /> J <br /> Z16. GENERATORS CERTIFICATION: I hereby declare re that the contents of this consignment afull/and accurately described above by proper shipping name.and ate classified, <br /> O packed,marked,and labeled,and are In all condition <br /> respects In proper for transport by highway according to applicable International and national govemrnent mgubnont.. <br /> QIf I am a large quantity generator,1 certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree 1 have determlied to be <br /> Z economically practicable and that I hove selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> = threat to hurron health anal the environment;OR,r I an a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste <br /> monogement method that Is ovoilable to me and that 1 can afford <br /> J <br /> PMted/Typed Nome Signghue .. _ Month Lay year <br /> /' / Z <br /> l <br /> ria T 17.Transporter 1 Acknowledgement of Receipt of MateriaIv I I r0 I I <br /> C Prnted/T <br /> O R A yPed Name t:C(f- sig we r, . ._ �., 1 Month Day yea <br /> , <br /> z N <br /> w F <br /> wO 18.Transporter 2 Ac wledgement of%cei t of Material + <br /> R Print ed/Typed NaSignature Month Day yea <br /> LU no <br /> UL E <br /> 0 R 1J•�/(/:r'l /T..� � (.� �L/'}Cp (-''''<%'' 7'r Y' r*-Y dra�...s,�, � I� �� I�^ � <br /> F 19.Discrepancy IndIrtlon space <br /> U A <br /> z C <br /> 1 <br /> L <br /> 1 20.FocABy Owner or Operator Certification of receipt of tazordous materials covered by the manifest except as noted in item 19. <br /> T Pdnted/Typed Name Signature Month Day year <br /> Y <br /> 11,0J2,7i IL <br /> DO NOT WRITE BELOW THIS LINE— , <br /> DHS 8022A<121M ' „ "Yellow:, TSOF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> EPA 8ftID-22 <br />