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_710 Environmental Protection Agency No.2050-0039(Expires 9-30-99).4 See Instructions on back-of 6. Department of Toxic Substances Control Arm designed for use on elite,(12-pitch)ty, sr. Sacromento,talifornia . TIIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page T Information in the shaded areas is not required by Federal law. WASTE MANIFEST Cl Al DI 91810161715115 of .. ` Generator's Name and'Mailing Address - .- A. State Manifest Document Number p„ 'lei.J. Heins Cosany. 4 . .( PO Box 57; Stockton, ^�'��''f_95201 - - B. State Generator's ID 4. Generator's Phone ( 209) 932-5752 1 N 0 T I I R El Q1 U 11 ,R1 $i ,D 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID(Reserved.] 1)elta Oilf eld S wSvl�s Inc. ICIAI DI 9181616191 551 61 Q 1 -5 ,- D. Transporter's Phone 530/66 r 4 7.Transporter 2 Company Name 8. US-EPA ID Number E; State Transporter's ID(Reserved.) " _ - F. Transporter's Phone - V 9:Designated Facility Name and Site.Address 10. US EPA ID Number G. State Facility's ID B&J iandf ill I C1 Ai P1 9j 81210141214171 5 O 6426 Ha Road H. Facility's Phone � rlii 1'l 5687 CAp987042475 707/4:51-3276-� - - 12. Containers 13. Total 14. Unit 11. US DOT Description(including Prater Shipping Name;Hazard Class,and ID Number) ' u_ � No. Type Quantity Wt/Vol `ti �T;;, Z a. State RQ &sbest—os, 9, iM 2212, 1-IGIII (NAERG071) 151 L EPA/Other 'O '..E b. - State 00 aD E R EPA/Other . A C. State o T CP EPA/Other -. d. State Z LU U EPA/Other LU N J. Additiondl Descriptions forIMateriafs Listed+Above K. Handling Codes for Wastes Listed Above O .��.QZA�S� .1C'i"`-lig� `1-1�S ��,.B,.4,!1�.{''1.3.�`I',-F CV b. V LU C. d ,O 15. Special Handling Instructions and Additional Information 24 HouR R ,4r•��RICI 530/60''2-2841 Jdb #45033 Z , Wlta: PO Box 1675; Woodland, CA 95776; EPA REGICXN IX: San Joaquin Valley APCD; w4230 Kiernan Ave #130; Modesto,, BESC CA, 95356; ASOS REMVAL Pik MOW 40 CM 61 F ZGo SEAM) & LABMM!. SITE: 2800 S Com.;lifornia St; Stodkton, CA 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, Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national governme-nl regulations. t If l am'a.lorge:qubntiy generator,1 certify that i have a proggrom in place to reduce the volume and toxicity of waste.generoted.to the degree 1 have determined to be economically practicable and that I have selected the practicable method aF,treatment,storage,or disposal currently available to me which minimizes the present and Future threat to human health N and the environment;OR,if I am a small quantity generator,I have made.a good faith effort to.minimize my waste generation and select the best waste management method that is d available to me and that I can afford. } anted/Typed N me Signature Month Day Year Z 0141 X '2 �w T 14.'Transporter 1 Acknowledgement of Recei t of Materials R LU A nted/Typed Name �1/(�r yE�l a �IdI77�. Signature i'� Month Day Year S Cob 3 LU P w 0 -18. Transporter 2 Acknowledgement of Receipt of Materials 0 T Printed/Typed Name Signature Month Day Year LU E N R - V19. Discrepancy Indication Space F 7 Z_ .. .. C f f 20. F' '' Ow er or O erafor grtyfica on of receipt of Ifazitirclous materials c vered this _an'fest Ace t ay noted t 7 T P: ted/Typed ame (� P� r Sig !lure /+Iv�nthy? /Yea Y f i r r i DO NOT WR4t BE�O �TI�IS LINE. ' 1"ellow: TSDF SENDS THIS COPY.TO GENERATOR WITHIN 30 DAYS. i SC 8022A 1/99 (Generators who submit hazardous waste for transport out-of-state, ` ) produce completed copy of this copy and send to DTSC within 30 days.)