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- - - --- - -- - - - - - - 7 - . - - I - . - . . - - .- <br />State of Call form io—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 )Expires 9.30-99) See Instructions on back of page 6. <br />Please print or type. Form designed For use on elite (12 -pitch) typewriter. <br />O <br />n <br />CV <br />in <br />C? <br />ca0 <br />ca <br />OJ <br />�Q <br />�U <br />0 <br />C <br />a <br />ac <br />c <br />c <br />a <br />ON <br />LL <br />t- <br />2 <br />LL <br />L <br />LL <br />Lf2 <br />C <br />u <br />0 <br />C <br />L <br />Department of Toxic Substances Control <br />Sacramento, California <br />DO NOT WRITE BELOW THIS LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 8022A (1/99) To: P.O. Box 3000, Sacraments, CA 95812 <br />EPA 8700-22 <br />I' Generator's US EPA ID No. Manifest Document No. <br />2. Page I <br />Information in the shaded areas <br />UNIFORM HAZARDOUS <br />is not required by Federal law. <br />WASTE MANIFEST <br />IW1941016010 I I I I 4) 2 21 <br />of 1 <br />3. Generator's Name and Moiling Address MIRACLE MILE DRY CLEANERS <br />A. State Manifest Document Number <br />82 W CASTLE ST <br />24624090 <br />STOCKTON CA 95204 <br />B. State Generator's ID <br />4. Generator's Phone 12 0 9) 464-0411 <br />5. Transporter 1 Company Name 6, US EPA 10 Number <br />C. State Tronsporter's ID [Reserved.) <br />SAFETY-KLEEDI SYSTEMS. INC. TXR11?9591 <br />D. Transporter's Phone <br />7 Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID <br />F. Transporter's Phone <br />9,Designated Facility Name and Site Address 10. US EPA ID Number <br />G. $tote Facility's ID <br />000760 <br />icopqo`T`8�17 <br />SAFETY-KLEEN SYSTEMS, ,INC <br />H. Facility's Phone <br />6000 88TH STREET rAll 0845 7 <br />S C O C 958 <br />9 n 7186-4913 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12 Containers <br />No. <br />Type <br />13. Total <br />Quantity <br />14, Unit <br />Wt/Vol <br />I. Waste Number <br />o <br />Stora <br />WASTE TOXIC LIQUID, ORGANIC N. O.S. <br />741. <br />EPA/Other <br />(TETRACHLOROETHYLENE)6.1 UN2810 PGIII <br />3 <br />DF <br />C <br />P <br />G <br />RO( FO02)( 13 G)(ER &15 ) 007, DO39. DO401 <br />F002 <br />E <br />b <br />Stare <br />N <br />E <br />EPA/Other <br />R <br />A <br />State <br />T <br />c <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 />a, <br />b. <br />I(A) D007 D039 (A) D040 <br />14 <br />c- <br />d. <br />15. Special Handling Instructions and Additional Information 0612 107157879 0031440221 0002508564 24 <br />EMERGENCY RESP#800-468-1760 24HR <br />SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIER, AS NECESSARY. <br />A 12627 B C D <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurate)y described above by proper shipping name and are classified, packed, <br />for by highway to applicable international and national government regulations. <br />marked, and labeled, and are in all respects in proper condition transport according <br />i <br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />disposal available to me which minimizes the present and future threat ro human health <br />practicable and that I have selected the precticoble method of treatment, storage, or currently <br />and the environment; OR, if I am a small quantity generator, I have made a good faith eFfort to m;nimize my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />Printed/Typed Nome Si r nth <br />2-MoDay Year <br />6 <br />43 <br />17. rens orter 1 Acknowledgement of Receipt of Materials <br />T <br />ped <br />ed Nome ig turo �"" Month Day Year <br />P <br />p <br />1 Trans iter 2 Acknowledgement of Receipt of Materials <br />Month Day Year <br />TPrinted/Typed <br />Name Sign re <br />E <br />R <br />j19. <br />Discrepancy Indication Space <br />F <br />e A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials <br />this manifest exoted in Item 19. <br />covered b ce t as n <br />Month Day Year <br />I <br />Y <br />Printed/Typed Nam <br />l ll, � 0,�s,/L ,d <br />Sign <br />U 3 9- D <br />DO NOT WRITE BELOW THIS LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 8022A (1/99) To: P.O. Box 3000, Sacraments, CA 95812 <br />EPA 8700-22 <br />