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cramas.arrracn - See Instructions On k- mak-of Par <br /> B-0..,:-' Deportment ofToxicSubstancesG <br /> tr Form Approved OMB No.2050-9039.(Expires 9-30.9at Sacrament*,Californiaa <br /> I Please print or form designed los use an efife ikh)typewriter. <br /> I� shaded <br /> UNIFORM HAZARDOUS 1 Generator's us EPA ID Na. MamFest Document No z ' 2 Page 1 ' Informafiao a the Federal <br /> areas <br /> c c is not required 6y Federal law. <br /> WASTE MANIFEST a �" of <br /> i 3. Generator's Name and Mailing Address <br /> LOCAL FWD =RE - LIAGAT KA P <br /> 2132 WAQM HEIGHTS ROADo S113CMDl, CA 95209 . E <br /> rrf <br /> A. Generator's Phone'( M _ t <br /> C14 5. Transporter 1 Company Nome 6. US EPA ID NumberCP <br /> yy <br /> I c NOR CAL OIL A ID 19 le 12 14 11 17121515 <br /> o <br /> 7. Transporter 2 Company Nome '8. US EPA ID Number <br /> 1 J - <br /> a V 9. Designated Facility Name and Site Address 10. US EPA ID Number di;r tll + <br /> f.tr <br /> �. a. MMUSTRIAL. SEWICEr OIL CO. ' <br /> I ck 1700 S. 'SOTO ST. <br /> _ toRai4 a 4 <br /> o LOS AI-GELES, CA 90023 CAU 0 9 9 4 5 .2 ? 0 8 �' <br /> w <br /> 12. Containers 13. Total 14. Unit <br /> V11- US DOT Description{including Proper Shipping Nome,Hazard Class,and 1D Number{ No. Tyres Quantity Wt/Vol os1e um 1.1 <br /> co <br /> IM-RCitA HAZARDOUS WASTE LICUID' M <br /> /VOthei'6 "t <br /> 3 ( 'Tk,R & SLUDGE) 01011 7 T G. 2 <br /> € r b. lA <br /> o N <br /> t £ <br /> RLL <br /> ' <br /> Q A <br /> C. a <br /> R14.1 <br /> k M fir, "-C •}'! <br /> d. <br /> Z � <br /> r. .. ;, <br /> 'rnooali[)s"scn iorlJloterl'1I issiei7:Abore � �` �Wos�ei�stedi ,a �' <br /> Uj <br /> Me <br /> 1 � f ' ' Ir <br /> Q .: <br /> q 0 15. Special Handling Instructions and Additional Information - <br /> a APPWPRIATE Pr==F& CLArt D)G, JM SITE t. LCC-kL-� ST <br /> UkE <br /> Z "I:.atFcC;EiCY CONTAv^Tt (209)sb7--6692" 2s5Ct MC :TE DIl�i3w <br /> SEE E.R.G. 171 <br /> Q16. 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 /> V. <br /> marked,and labeled,and are in oil respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantiy generator,I certify that I hove a progrom in place to reduce the volume and toxicity'of waste generated to the degree I have determined to be ecenorr icolly <br /> a practicable and that I have selected the practicable method of treatment,storage,or disposal currently available tome which minimizes the present and future threat to humon health <br /> w <br /> and the environment;OR,if I am a small quantiy generat6r,'Ihove mode a good faith effort to minimize my waste generation and select the best waste management method that is <br /> o available to me and that I can afford. <br /> } Printed/Typed Name - 'g atur Month Day Yew <br /> U <br /> q1 {1 <br /> T 1-7. Trons rter 1 Acknowledgement of Receipt of Materials <br /> W Printed/Typed a - Signature Month Day Yeot <br /> f- x1 <br /> 0 .8 18. Trans orter 2 Acknowled ems f.Kecei i of Materials <br /> R Printed/Typed Nome Signature Month Day Y..i <br /> T <br /> � E 1 <br /> R � <br /> V 19. Discrepancy Indication Space <br /> z F <br /> A <br /> C <br /> i ` <br /> f f 20. FacilityOwner or Operator Certification of receipt of hazardous idaterials covered is manif e t as noted in Item 19, I <br /> 4 T Printed/Typed Name - Signatu Month 'Day Yea" <br /> f Y' <br /> 1 <br /> - (.-� -�,::�._ fide.`-1 Yom,t%. <br /> DO NOT WRITE ELOW TH S LINE. <br /> DTSC 8022A(4/97) <br /> EPA 8700-22 Green: TRANSPORTER RETAINS <br /> � r - <br />