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01/30/2003 09:37 20983677136 SAN i PAK PAGE 06
<br /> S( y ol•Cafifornio—Enwirenmenlal ProlecNon Agency
<br /> ?::');otie Appmv;Od OMB No:20li0`0034,(Enp•Irr►9.30-941 See Instructions on back of t �a b. Department of Toxic Substances Control
<br /> t(cele print or ype. Porm designed for use on elite(12•plkh)typewriter,
<br /> Sacramento,Colifornio
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<br /> 1.. 44,WoEPA ID No. MI Into motion in the shoded oTeas
<br /> UNIFORM HAZARDOUS':°;•;. : ror"s:US crDocument No, 2. Page 1 is not required b Federal low.
<br /> 'WASTE MANIFEST 47B 3 0l Y
<br /> �✓" 3. C"neralor't Name and Mailing Address;< SAN •I' AK I NC A. State Manifest Document Numb•r,.
<br /> • 00 BOX:�I iso 1+_���y�i 21738737,:
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<br /> TRACY CA: 95378 8- $fak G.nerabr'.ID ,
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<br /> �.�,•.: '4. eneratare Phone(,iV 7f OJ►"i'�J�V1' .
<br /> S. Transporter t company Name'
<br /> sp tnPo Y 6, U5 EPA ID NUmbeT. C 51ah Tronsporler's ID(Re*�rvad,J
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<br /> SAFETY'-KLEEN SYSTE'�N4�rr,'' Jwc R 7 D, Tronsporter's Phone
<br /> 7,'Tronsporter 2 Compeey Nome 8, US'EPA'ID Number E. Slate,Transparbr's ID lRegerved',J
<br /> I 'Transporters Phone,
<br /> L}i 9: Desi noted Facility Names and Site Aditrliss 10. US.EPA ID Num r G, 51oq ilt
<br /> = SAFTYKIrEEPf. SYSTEMS i Y > ....l.... r+
<br /> . 1800 88�4T,H. STREET /.�/y��/. . T
<br /> SACRAb1E�iT0 WA. 9582 CA08000045YF H, foeilify'tPheme j
<br /> 914 384-49i
<br /> 12, Containers 13, Total Tl, Ung
<br /> a J't:'US DOT Description(including Proper SKippfngName,Hosard Class,and ID Numbed
<br /> x ..No. T Chwnliy VAI I:Waste Nwm1I.. .
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<br /> WASTE PAINT RELAT �► TERIAL► ::3 axe
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<br /> iie+r, ..�� IJ5b03 l FOGS
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<br /> ,� III A PIP 4r III
<br /> �#4 �UTHQRIZEII' (H .L` .C' Mi�ED;'SVOSEQUENT CARRIER, AS NECESSARY..
<br /> + >: •\ Yip +165 �1 -
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<br /> :16:GIENbRA10!l'E CEIITVICATipft! 1•heieby dad.re that iherronteab•ef.fhis contiyrunerd pre Fully and accurately described abovs by proper shipping name and are dossihed,packed,
<br /> ;•,,:, :• marked,and labeled;and are in oll.respeofs In proper.eandiflot'r kWiransport by Iflphvray according to applicable international and national ge>emmant vlgulaliens.
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<br /> ,, '•} If i om o large quantity generator,10 that I'haye,o pr ram'in place to reduce.IM volume and b iciyy of waste generated ro the degree I have determined to be economically
<br /> ."prncttcable and}tial I hove selected Ihe• rw kable''ntetltad�freatmenl,slonap'breFisposat currently oval to me which minimizes the present and future threat to human health
<br /> r c 1•.' -and the environment;OR,IF I am o sr�gtlanilly generator,I 1 made a good Folth effort a minimize my waste generafian and sef.a the bast waste monogement method that if
<br /> e�CC available to me and that I can offord,
<br /> (: ',•[,_Printed/Typed oma Signature p Month Day �Ylear
<br /> Sit I ;{1a r 0 r 4
<br /> 17, Transporter AcImowled emani of Roc 1 MaletS.
<br /> j :•Prim /T ped Neale..'a .. ; SjgpatgN... ,MoMh� ,-,Day. Year .-
<br /> M 1617 CA t J
<br /> y-18, 'Transporter 2 Ackaowlsid emenf of Revel f bF MtsleAalS
<br /> Printed/Typed Name - Si�isoWre Month Day Year
<br /> ' 19, Dtxreponcy indication Space i
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<br /> Facie l7wrMc or rafor Certs katlon`of revel .of 'W cut ma s,t avare . 1 i es snf s noted i m 19,
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<br /> lad/Typed Name na b s Mant Day_ Year
<br /> MadQ .r
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<br /> W91'tE B bW ELU E.
<br /> haw: TSDF SENDS T S COPY GI NEkATOR WITHIN 30 DAYS,
<br /> Generotort who s ozardous waste for'trons out-of-slate,
<br /> �i5t B022n I l/99) ( I
<br /> �`o*8700---27 produce completed copy of this copy and send to DISC within 30 days,)
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