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State of calif nia—Environmental Protection Agenc 7---.-i 85•-0 l Fo .pproved OMB No.2050-0039(Expires 9-30 99) See Instructions On back of Page 6. Department of Toxic Substances Control Please print or type:- Form designed for use on AIR f 12-pitch)typewriter. Sacramento,California UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas CAT 01 00261f 20 005 85 � # is not required by Federal law. WASTE MANIFEST of 3. Generator's Name and Mailin$Addre s T'A= ,l I- 4- .tf::1-L.. A. State Manifest Document Number i•'1�f BOX 1tJ'�u• Rta�'?"! :.irt,J��J0N tt�� _ 23514712 SAN RAMON S-;ri 7'`�:?.�a,��-"��'� t B. State Generator's ID LO 4. Generator's Phone( 209 47.4-401 •�; s 'i ��' d'�t•.(.J�'-q n N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] LO CP C-1A~ r --�{.LEEN SYS EMS, INC r XI�O{�`.�'-?�]1.- - D. Transporter's Phone 800 660-5740 00 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] Transporter's Phone Desi �{ey!Fac)'l�i�f't�{1,�,- aand Sit$ asst L sY`/1`'' 10. US EPA ID Number G. State Fgcili 's ID i 7` W�L..,C 1=.t�f ,C7*i:7: t. til M1_ }� �J 5050 —SALIDA PL-VD SAL.IDA CA 9536B CAT(J70t:5.13968 H. Facility's Phone tpds�q)O 209 545--1011 `•'Q 12. Containers 13. Total 14. Unit ' 11. US DOT Description(including Proper hipping Name,Hazard Class,and ID Number) `vU No. Type Quantity Wt/Vol I. Waste Number USED CL.>�.ANIN GL�T'rf�'O JNDSr N. 0. I. H. N. C:r $tate 134 �_I QU T D (NOT USDMT OR U.S`s!=_f-A REGULA i Flt 1 / EPA/Other G AGIIJEOUS PARTS I4SHER 801—U T ION o N b. State 00 00 E EPA/Other 4 R 7 A State O T 000 O R EPA/Other H d. State Z w U EPA/Other w N J. Additional Descriptions for Materials List d Above X. Handling Codes for Wastes Listed Above Z a- 1401, b. LU C. d. Z 15_5 ecia, tion dp � stry ' jr' /---17`',s 7`''i' !r'. .'v„_c'in}..;:t-•'•, u�w'v u _..:r C"1- 2zi•i-{T3`+. Q Z w A Al I D � D E S MILE E RD STOCKTON 16. GENERATOR'S CERTIFICATION: I here y declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, Q marked,and labeled,and are in all re acts in proper condition for transport by highway according to applicable international and national government regulations. U If I am a large quantity generator,I ce tify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economic 11 practicable and that I have selected the practicable method of treatment,storage,or disposal currently ailable to me which mini zes the present and Future threat to human health N and the environment;OR,if I am a small quantity generator,I have mad a good fait •'effort to minim' a my waste generation a select the best waste management method that is Oavailable to me and that I can afford. r _ y. Printed/Typ Name Signature �: Month Day Year Z , rZ p w T 17. Transporter 1 Acknowledgement of Rec t of Materials � R w S Print Na� $ignafu '�- nth Day Year w J iE/ / ,q c! /� - 7;�, 'R ale-? o v P i w 8 18. Transporter 2 Acknowledgement of Rece pt of Materials 0 RT Printed/Typed Name Signature _. -. __ .- -- - ---- 'Month- Day Year LU E V19. Discrepancy Indication Space Z F — A C 1 L I 1 20. Facility Owner or Operator Certification of receipt of hazardous materials cove d by this manifest except as noted in Item 19. TPrin)edTTyped Name Signat re \ n Month Da Year ,\ / -•� DO NOT WRITE BELOW THIS LINE, j -t1 Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 8022A(1/9.Y{`� {N_ - (Generators who submit hazardous waste for transport out-of-state, EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) - ENILA ,