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Statb'oF Californianvir nme al Protection Agency `... Form Approved OM No. 039(Expires 9-30-99) See Instructions on back a 6. Department of Toxic Substances Control Please print or type, Form designed for use on elite(12-ph, iter. Sacramento,California 1. Genera or's PA ID No. Manifest Document No. 2. Page 1 Informgation in the shaded areas UNIFORM HAZARDOUS is not required by Federal law. WASTE MANIFEST A 00 f3 9972 a fP ' 1 E3 3. Generator's Name and Mailing Address H HEINZk?anifest Document Number' 804 S CALIFORNIA 23023981 . P. O.- BOX 57 0 STOCKTON CA 95206 e slate Generatar s ID V4. Generator's Phon t•'s n r �(ao� 93z-s75g CV 5. Transporter 1 Company Name - 6. US EPA ID Number. C. State Transporter',ID[Reserved] LO i' 2103 oSAFETY-KLEEN SYSTEI , INCT R O 5 3 :D..Transporter's Phone O x ri i' ri 7 ti 7. Transporter 2 Company Name " 8. US EPA ID Number E. State Transporter's ID[Reserved,] ©Q .1P }' /f _ J,• _E Transporters 9. Designated Facility N•me and Site Address 10. US EPA ID Number .a/J G State Fa (ity s ID - a00©658 615.E 2f, 1 42 SAFETY-YLEEN;. SYSTEMS; INC. 0 ✓ 3700 LAGRANGE ROAD K DOa3 48 08 H Facility's Phone LL SMITHFIELD KY 40068 "s0 2 8 liS- 2 4S UJ 12. Containers 13. Total 14. Unit .11..US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. I Type Quantity Wt/Vol :I Waste Number Z a•' - }State .NON REGULATED LIQUID 3 G M 1.J i„1 EPA/Other E Ni- 0 N b. State ao E v R 'EPA/Other v A — 0 T c• 5+;te a0o O _ R _ - 'EPA/Other d. LU V *- �, }, - , 1 _ . A. EFA/Other W J Adaitiana 5'criptions for Mater als Listec Above K. Ho,dlira Codes for Wastes Listed Above - - 1 AiL ' Wad c d. O 15. Special Handling Instructions and Additional Information F- MFST R T 104712327 0002-2481-•68 Z EMERGENCY RESP 800-468-1760( 24 HR ) . IF UNDELIVERABLE RETURN TO GENERATOR. SK CORP AUTHORIZED TO , RETAIN. LICENSED SUBSEQUENT CARRIERS AS NECESSARY. W s - 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above 6y-proper shipp'ing name artd are classified,packed, Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and notional government regulafions. J_ If I am a large quantify generator,l certify that I have a program it place fo reduce the'''lume and toxicity of waste generated to the degree I have determined fo be economically CL practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to.human health and the environment;OR,if I am a small quantity generator,f have made a good faith effort to minimize my waste generation and select the.6esf waste management methodthat is Q available to me and that I can afford. } Printed/Typed ' Signatu 1 o Da' e Z f ^� t W T 17. Tra orter 1 Acknowl ement of t ei t of rials r Uj N Print /Typed Name +. ��' Stg tune. —T3onfl a a S , O0 18. raps otter 2 Acknowledgement of Recei t of aterials T Printed/T ed-Nam e Signature _ r... "Month Day Year to R t' U 19. Discreppncy Indication SpaceLu E l s4 Z F �f _ A f- �'. F MAI' - 3 2004 I . Nci ity Owner or Operator Certification of receipt of hazardous materials toveiecl 6y this manifest ea t U n d in Item 19. T` pri YP d ama1 Sig fuFo.1. ( ...�... thi Ddb Yea DO.NOT WRITE BELOW .THIS LINE: A�1qYL,# A l0002z088.r78 { ,Ye llow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. ' bP5 66#2A (Al/99Qj int`,� 1 J; (gVerators who.submit hazardous waste for'tronsport out•of-state, EPA 8700-22 prjzdute completed copy of this copy and send to DTSC within 30 days.)