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State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9.30-991 See Instructions on back of page 6. Department of Toxic Substances Control <br />Please print or type. Form designed for use on elite 112 -pith) typed r.13 5 - 01 Sacramento, California <br />,qr c? <br />CD J <br />C%jU <br />r— Q <br />NZ <br />Op <br />J <br />Cq U <br />N <br />O <br />00 <br />00 <br />v <br />N <br />V <br />0 <br />O <br />ao <br />ac <br />LU <br />Z <br />V <br />w <br />N <br />Z <br />O <br />N <br />aC <br />a <br />Z <br />O <br />a <br />Z <br />LU <br />F_ <br />Q <br />U <br />J <br />CL <br />V) <br />DTSC 8022A (1/99( <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS LINE. <br />6215.0991 <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 3000, Sacramento, CA 95812 <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />1F A= 8 6 3 r. 0 8 2 415 <br />of i <br />s not required by Federal law. <br />3. Generator's Name and Mailing Address MIRACLE MILE DRY CLEANERS <br />82 W CASTLE ST <br />A. State Manifest Document Number 5 42 72 6 4 <br />STOCKTON CA 95204 <br />B. State Generator's ID <br />4. Generator's Phone ( 2 09 4 6 4— 0 411 <br />S. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID Reserved.1 <br />SAFETY—KLEEN SYSTEMS. INC. T 0000 0'130 <br />D. Transporter's Phone <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID [Reserved.] <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />000760 <br />A: 4 O 5 7 <br />SAFETY—KLEEN SYSTEMS. INC <br />H. Facility's Phone <br />6000 88TH STREET CA0000084517 <br />SACRAMENTO CA 95828 <br />916 386.-4913 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number( <br />12. Containers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/Vol <br />I. Waste Number <br />No. <br />Type <br />a WASTE TOXIC LIQUID. ORGANIC N. O. S. <br />State 741 <br />(TETRACHLOROETHYLENE)6.1 UN2810 PGIII <br />DF <br />P <br />EPA/other <br />E <br />RQ(F002) (13#/G) ( ERC;#153) { D007, D039, D040) <br />F002 <br />N <br />b. <br />State <br />E <br />EPA/Other <br />R <br />A <br />T <br />C. <br />State <br />O <br />EPA/Other <br />R <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes <br />Listed Above <br />I(A) D007 D0 39 { A) D040 <br />a. 14 <br />b. <br />C. <br />d. <br />1�EasrInformation� J 2 4- <br />ERGENCYRESP#8001468-1760 24HR <br />SK ALrTHORIZED TO RETAIN LICENSaED ZUBSEQUENT CARRIER. A:; NECESSARY. <br />A 12f 27 T: r. G <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, 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 large quantity generator, I certify that I have a pro ram in place to reduce the volume and toxicity, of waste generated to the degree I have determined to be economicallyy <br />Practicable and that I hove selected the procticable method o� treatment, storage, or disposal currently available to mew 'ch minimizes the present and future threat to human heolth <br />and the environment; OR, if I am a small quantity generator, I have mode a faith effort ro minimize waste meta 'on nd select the best waste management method that is <br />available to me and that I can afford. <br />PteMTyped <br />Name q► <br />Month Day Year <br />G <br />07 016 OIG <br />I <br />17. Trans rter 1 Acknowledgement of Recei t of McLj.11Jls <br />A <br />Printed/ ame Signature Month Day Yeor <br />o --)I 1G o 16 <br />Is <br />0 <br />l8kofrimsportr 2 Acknowledgement of Receipt of Materials - <br />TPrinted/Typed <br />Name <br />Signature <br />Month Day Year <br />-E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered 6y this manifest except as n d in Item 19. <br />T <br />Yiir <br />Pr"in�t /T ed Name <br />Zgnre <br />;� <br />Month Day Year <br />D7e 7j <br />DTSC 8022A (1/99( <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS LINE. <br />6215.0991 <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 3000, Sacramento, CA 95812 <br />