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10/18%02 FRI 09:22 FAX 949 450 1.177 B.E.S. I. 10 004
<br /> Stsle of Californio-Environmental Protection Agency
<br /> Form Approved OMB No.2050-0039(Expires 9-30.991 See Instructions on back OfP a9 e 6.
<br /> Please print or type. Form designed for use on elite(12-pitch)typewriter. Department of Toxic Substances Control
<br /> Sacramento,California
<br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No, 2. Page 1 Information in the shaded areas
<br /> WASTE MANIFEST 0 O s not required by Federal law,
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<br /> 0 15. Special Handling Instructions and Additional Information itf
<br /> Q Gasoline and Water mixture. Wear appropriate protective clothin& -ARCO 2133 RFSI# 512 57
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<br /> Z (949)753-5826(24 hour EmergencyPhone) 2908 Beni arninHolt DriveLU
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<br /> (949)450-1010 CMon-Frilam to 5Um) Stockton,CA f:'';MAiEAIAt
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<br /> Q 16. GENERATOR'S CERTIFICATION: I herb declare that the contents of this consignment are Full and accurately described above by proper shipping name and ore classified,packed, '- -
<br /> marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations,
<br /> If I am a lorge quantitygenerator,I certify that I have a proggram in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economically
<br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently ovailable to me which minimizes the present and future threat to human health
<br /> and the environment;OR, if I am a small quantity generator,I have mode a good faith effort fo mini waste generation and select the best waste management method that is
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<br /> available to me and that I can afford.
<br /> VPrinled/Typed Name Signature Month Day Year
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<br /> W T 17. Transporter 1 Acknowieclement of Receipt of Materials
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<br /> LL0 18. Transporter 2 Acknowledgement of Receipt of Materials
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<br /> L) F 19. Discrepancy Indication Space
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<br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest exca t s noted in Item 19.
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<br /> � � $ignofure Month Day Year
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<br /> SENT E
<br /> DO NOT WRITE BELOW THIS LIPA.
<br /> DTSC 8022A (1/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS.
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