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.Slat!OfCafifarnla--'Earrranmental P.M—Jl"gerre�� r Tj�•z ei ':r, .w.ta,.y;z-a.`.' .7A .'i'R,'a';''��;;rtS`i:-f6. ;.�' 4r a�f_ i '1 5 <br /> Fb mApproved OM9Na- ptres 9-3D 99}, �� iiip Sie InstPUetIOTIS oA Ba'c&W'og$ i , ' t t peporhnenlof Toxic Substances Canto <br /> Fleoseintor.ly {:fbrmdesignp }T -s tsvp '" rhe•`.± Sauomento,Califomw k <br /> t- - T: Genera s US EM"Ll Tlo p. '��' +Manifest Dacum py Z Poge 1 'Irrformatioa iP thQ lhoded Onset- r <br /> Y �EST_ q". <br /> .• 1 it n not required bYFedaral law <br /> C+ <br /> ::r -' „� „}ofJ ,_ » •':ter ,J�. -. <br /> sr, <br /> ...3. Generators Name and Mailing Addresfikcr 3 s <br /> Ot_.AL FOOD STORE <br /> its i, 2tWA(�h3ER. HEIGHTS ROAD, 'STOCkTOW� CA: 9 209 <br /> Generarors.Phane �1 p464-2750 3 <br /> C4 5 Transporter 1 Com any Name _. •.. 6. US EPA ID Number <br /> - <br /> 00 <br /> OR:.GAL .OIL'. . <br /> � -AD. 9. 8 : �# f 7 2 55 <br /> w <br /> r <br /> ..7. Transporter 2 Company Name <br /> ' .P° Y " : -. .. : $. US EPA ID Number •.''" <br /> 44 <br /> N �� a��Y Nva drer�I L CO. 10. US EPA ID Number <br /> Q � <br /> �z 700 S-..'-S©TO ST. <br /> �Lj_ <br /> 0 QS ANSELES, CA. .90023 1AT _: 8 � <br /> J <br /> s k. <br /> Q 11. US DOT Description(including Proper,Shi in Noma,Hazard Clsi,and ID Num 12• Containers 13. Total 11, Unit <br /> CJ P 9 Pp g. ball No: Type Quantity Wt/Vol <br /> .V z _ - <br /> '1?r Oi+i=iIGRA. Hf�ZAR©DUS WASTE•_LIQUI <br /> W D <br /> — <br /> WATER <br /> !k SLUDGE <br /> 3 - <br /> o G <br /> ' coco <br /> E ' r, <br /> v A <br /> Q T: _ -- - - <br /> - - - _ - <br /> m - <br /> __ _7. <br /> LU d .r <br /> Z <br /> ,.. - <br /> fJ _. - }m LU <br /> - S <br /> tr ? Y <br /> f <br /> Lu <br /> a <br /> 1 S. Special Handling irtstructions and Additional Information <br /> ' APPROPRIATE PROTECTIVE CLOTHIN' <br /> „� __� <br /> Z 'EMEkGENPY: COt�lTAr`T e {209)541 9145" _ _ =._.SITE ADDF'ES r <br /> EE E.R, G I71 ,p 6gt3 MC}NTE D I A£�I_Q . <br /> ` t STOCKT31'J ` <br /> ,. ,-- a_ 95203 <br /> r <br /> Q 16. GENERATORS CERTIFICATION I hereby declare that the contents of th*s consignment are fully and accurately described above by proper shipping name and ore classified,packed, <br /> marked and labeled and are in aR respects m proper condition for transport by highway according to applicable infernational and nationail goremmenf regulations. <br /> J If f am a forge quanti generator,I certify that fwre a pr ram m pfoce fa roduce the volume and toxicity of waste enerated ro the d <br /> HT cy b g agree I have determined l0 6e ecoeomically <br /> w practicable and that I have selected the practicable method of treatment,storage,or disposof currently available to-me.wbich minimizer the present and future threat ta.humon health. <br /> and the environmenT,OR,if!am a small quoa generaro,I have made a good failh'efforf to minimize m"y'woite Beneiotion and stied!be best waste management method That is <br /> 0 ovail6ble to me and that I catnafford, ,�. <br /> } Printe I Nome A <br /> V 1 J <br /> :519n tur Month DoHie- % <br /> m - <br /> rt <br /> Ld-4_�_. <br /> -,7/ <br /> A17. Trans iter I Acknowlecl ement of'Recei t of Materials <br /> A Printed/T Nome Si nature <br /> � Month NY r <br /> 18. TransE2rtar 2 Acknowledgement of Receipt of Materials ` <br /> T Printed/Typed NameUj <br /> StgnoNre <br /> •;.vj E _ _ - - - - ; Month Day Year <br /> Q R — <br /> j kJ = F 19, Discrepancy Indication Space <br /> z .A: <br /> j q 20: Facility Owner Operaw Certification f-;-1 t aidous materials covered by this manifest exce as o" Ite - 9: <br /> 1 Printsd/TYpod N <br /> Signature <br /> y' Year <br /> DO NOT WRITE,.BELOGV TH' 1 LINE:;. <br /> OTSC 8022A(4/97) <br /> EPA 870022 Green: TRANSPORTER RETAINS <br />