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Slate of California--Environmental Protechan Agency <br /> Form Apprggved OMB No. 2050-0039(Expires 9-30.99) <br /> lease print or type. Form designed for use on elite 112-pile'- 3wriier. + r,' See Instructions on back a e 6. <br /> + -� + `/� S Department of Toxic Substances Cam, <br /> ' Sacramento,California <br /> UNIF RM HAZARDOUS 1 Generator's ' IO ManiFesl Document No. 2 Page 1 information in the shaded preps <br /> WrTE MANIFEST F) 2 1 1 2 2 << q lj is not required by Federal law. <br /> I 3 1 of 1 <br /> 3:Generafo%aName and Mailing Address ' <br /> Colic «L'rucki.>Fg fa dt .J co- <br /> 0 <br /> W) 1'.O. `Rua. 30488, Stockton, CA. 95213 <br /> may. 7 <br /> N 5. 7ronsporler I Campony Name V 6. US EPA ID Number ,�s - <br /> 5#gfS <br /> CIP <br /> RAMOS- F'.? VIPrMtJFPPTAL SERVICES C A I) O1414101013 <br /> _ 7. Transporter 2 Company Name ^ ' <br /> B. US EPA ID Number - a <br /> J <br /> J <br /> 9. Designpled Fac ifity Nome and Site Address <br /> J Q RAMnS 4.T,1VTR01, q 10. US EPA ID Number <br /> vPll?r�TAL SERV?CE•S t <br /> �7 z 1515 SOTI'TN RIVER ROAN, WEST SAC(PAMPNT0, CA 95691 <br /> (a O �aEIIt}ytrPFon ; <br /> CAD04t> 003556 <br /> ry U <br /> 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) 12. Containers 13. Total 14, Unit <br /> .� a. No. Type ouantity WI/Vol <br /> NON-•RCRA HAZARDOUS tdASTr LIQUID t <br /> 3 E (0i1v +Anter/Rinsatet) NAERG96#17I <br /> ni bco <br /> = <br /> o <br /> c.'4A � <br /> o T <br /> m R #F <br /> IX <br /> w d_ <br /> Z >x+ <br /> U <br /> ,, <br /> Z k :: <br /> oa. <br /> LU <br /> as <br /> Ff. <br /> cX <br /> I5. Special Handling Instructions and Additional Information ^�� % 7 <br /> Z UANDLER S BF 40 HOUR, �FS!IA/SARA 'FRAINFJ., G- Site: 2660 Lommfg RoSd <br /> ANT) USE NlnSR APPROVED PPR, Stockton, CA. 95213 <br /> PMRGENCY Cl1NTY-7f: (916) 371-5747 <br /> 1 <br /> 16, GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described above by proper shipping name and are classified,pocked, <br /> Q marked,and labeled,and ore in alt respects in proper condition For transport by highway according to applicable internafianal and nal onal -.4; <br /> U government regulations. <br /> If I am a large quantily generator,I certify that I have o program in place to reduce the volume and toxicity of waste generated to Ike degree I have determined to be economical)gqi1 <br /> practicable and that I have selected the proeticable method of treatment,storage,or disposal currently,available to me which minimizes the present and Future threat to human heoltf <br /> and the environmenl;OR,if I am a small quantity generator,I have made a good faith eFFSrP10 minimize my waste generation and select the best waste management method that is <br /> 0 available to me and that I can afford. <br /> r Prinsed/Typid Name f =" ff Signature Mon/th/ D_ay" �.Yfepr�J <br /> Z tom, 1 t)`" (. <br /> 3 T 17. Transporter 1 Acknowledgement of Receipt ofMaterials 4 <br /> W A Printed/Typed Name Si nature -„ <br /> M r� "li 9 MontF7 �zDa ea <br /> w S (T� <br /> P <br /> LL 0 18. Transporter 2 Acknowled ement of Recei t of Materials <br /> 0 1 Printed/Typed Name <br /> LU E Signature Month Day Year <br /> U) R <br /> Q ' <br /> U # 19, Discrepancy Indication Space - <br /> Z A <br /> C <br /> L ' <br /> 1 20. acibly Owner or Operator Certification of receipt of hazardous materials covered by This maniFest except as noted in Item 19. <br /> T Print d/Typed Name Signalure Month :Pay Year <br /> Y �} <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAtif,,; <br /> DTSC 8022A (1/991 (Generotors who suhrnit huzmc6is v-0p.. For ironsport <br /> EPA 8700-22 produce completed copy of this ca}sem a,rd Aricl,.kq DTSC_ ,a+gt,.3f}'e�al.Y,Isr. <br />