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State of California—Environmentol Protection Agency <br /> Form Approved OMB No.2050-9039(Expires 9.30-99) See Instructions on back of page 6. Deportment of Toxic Substances Control <br /> Please print or type. Form desigped for use on elite 112-pitch)t -iter. Sacramento,California <br /> UNIFORM HAZARDOUS 1 terotor's US EPA ID No. Manifest Document Ns. 2. Page I Information in the shaded areas <br /> �r 7 �•) J 7M0� snot required by Federal low. <br /> WASTE MANIFEST O M <br /> 3. Generator's Name and Mailing Address A.,Siate. onifest Docum"t Number <br /> oO .e CJ-rru�x, �.y <br /> 3'S/00 B. stare venerator's IDr <br /> N 4. Generator's Phone Vol )41i(,(o-dap / 3 5-3'0 S <br /> t\ <br /> CV 5. Transporter 1 Company Name b. US EPA ID Number C:SIatrTFartsRort�r'srlQ'-�.,` <br /> co <br /> O ti,A IST E C.I.- n _ 10 -' v + ' D �faaosportef�r.Phe! ? ^' e r r , <br /> s <br /> C? 7. Transporter 2 Company Name 8. US EPA ID Number L State Transporte/3.ID'-. <br /> pp ,Wim'."". '_.:•. ,. .{• <br /> QIr..-fr•. - ,.`i.3ri �•V1lC>f�`+ -Y,ti�` '���`r�r. Nbrl.',•'. ,•. <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Slate Foabg(a,IG- '_ <br /> Q NUUS I KIAL ,tKVlla UIL CU, INC -APE1)'1) $ �^ <br /> ad 1700 S. SO.TO ST r� H. <br /> O t M CM 90023 C 0 V J S -4 S 2 ? b r, <br /> Q12. Containers 13. Total 14. Unit ;• ° ' - <br /> U 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. T Quantity Wt/Vol I..IWaste NwOber <br /> Z a ype <br /> Stoll " <br />= NON-RCRA HAZAROOLJS WASTE LIQUID 22& <br /> 3 It OILY 1 AT C R J r► T T G EY!►/odt!r�;r:_ <br /> N E sfotr <br /> 0 <br /> N b. <br /> act E FP�4lCldte�t^� r 4, <br /> v R <br /> CN A c <br /> o T -.;. <br /> ado O EPAlodw•' i' <br /> R - �. <br /> ocd. <br /> s�aN,:•° <br /> w <br /> ULU <br /> I + <br /> Z 1:Additional Doxriftions for Malmials Usred Abpye aL K Htsndltng Codes,for WaslesLated Above ti <br /> OILY WATER. s t s 04 _, , 4w..LU <br /> .. d a. <br /> a <br /> Z 15. Special Handling Instructions and Additional Information <br /> O <br /> Q GLOVES <br /> Z <br /> LU EMERGENCY PHONE 209-6674-4857 <br /> 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, <br />< marked,and labeled,and are in all respect!in proper condition for transport by highway according to applicable international and national government regulations. <br /> If 1 am a large quantity generator,I certify that I have a proggram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> practicable and that I have selected the rrocticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small quantity generator,1 have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> OPrince /Typed Name Signet I, J Month o �eor <br /> U <br /> r: e , Ih�r <br /> w T 17. Transporter 1 Acknowled em nt of Receipt of Materials <br /> oC A Pri yped Name Signature Month Day ,jeer <br /> LLJ M Y <br /> LU 5 (/ <br /> P r...• >'''�. <br /> w p 18. Transporter 2 Acknowled .moot of Receipt of Materials <br /> T Printed/Typed Name Signature }+' - Month Day Year <br /> w E <br /> N R <br /> Q v - <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19, <br /> T Printed/Typed Namt / Signature, - nth Day Year <br /> Y L�i✓r �/ fid <br /> DO NOT RITE BELOW THI LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> (Generators who submit hazardous waste for transport out-of-state, <br /> DTSC 8022A (4/97) produce completed copy of this copy and send to DTSC within 30 days.) <br /> EPA 8700-22 <br />