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drOrnia—H,"flh rtrtd Wn{ferp AOnn,IF "e1` <br /> eyed OMB No,2050--0039(Expires 9-;,� Ir.cir(iC!iOn' On t( nT PR^• _ <br /> Jf . 4 ,riot or type. Farm d^4igned <br /> for Wr.Ct' r!n(� r(;.n' r ` n � Toxic Sabi nrtces rfrn�nt of Health.59rv1.^ <br /> (r2-pifrh rYpnwrr7�r}, .�7_ % Control Divir- <br /> UNIFORM HAZARDOU Sg<rnmanfO.Calirc,- <br /> t. Gnnerarnr's US E%r+ tD r`ln, Mnnire <br /> WAST 51" 2. Page 1 <br /> E MANIFEST C A C O O U � d 7 0 a 7 d'pCrr"On,d0-1 lnfprmahnn m the shaded arena <br /> 3, Genera lot's N i Of 1 is not requirrort by Fgrleraf law. <br /> ams end Melling Address <br /> GRAHAM ROYALTIES LTD, A. afete Manifest Doc,,"'" Number <br /> 9571 So. Roberts Road, Stockton, CA 95206 900071159 <br /> B. Sfala Generator's 10 <br /> r, a. Generator's Phone{�2a(�� 91_8711 <br /> Transporter 1 Company Neme r,. US EPA 10 Numbvrr f <br /> H & H Ship Service Com an C. Trate TrrHI3 3 Tens rit) 1 00941 <br /> Compan 11CIA D O 0 4 7 7 1 1 6 $ D. 7rengpoer's Phone . <br /> 7. Transporter 2 Company Name � • � 3 <br /> 8• US FPA fO Number E. Stale TrsrtepoR9r'3 fD <br /> 'm JF. Yranauorter's Phone <br /> 9. Designated Facilily Namo and Sita Address • <br /> }rl. US EPA ID Number G. Stale Facility's l0 <br /> z <br /> H & H Ship Service Company .=.. i <br /> r U 220 China Basin Street CEAL1 O 01 41 71 7L1 1j 61 ,81 <br /> H. Facility's Phone _ <br /> Incc Z San Francisco CA 94107 1 C1 Ai Di 01 of 41 71 711 1 6 8 415 543-4835 <br /> 12. Containers 13. Total M, <br /> LL 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number} I• ' <br /> S� Ovenlrty Unit Waste No. <br /> Q <br /> U a No- Type WtrVolCD <br /> °i <br /> `.:D z G RESIDUE GASOLINE TANK state 512 <br /> '� � N (CALIFORNIA ONLY REGULATED WASTE • <br /> EPAJ01her <br /> � N R b. 001 TPOzaoo <br /> 0 A Slate <br /> Cc <br /> rc T <br /> O EPA/Other <br /> -r R c• <br /> o State <br /> cr EPA/Other <br /> Uj d. <br /> Z Stnte <br /> W <br /> U , <br /> w <br /> EPA/Other <br /> J. Additional Descriptions for Materiels Listed Above <br /> ` K. Handling Codes for Wastes Listed Above <br /> CL PUMPED OUT 2,000 gallon tank last containing a- 01 t.,b ' <br /> Q gasoline. Tank inetted with dry lee for t 'S <br /> transport. ^.d: <br /> Z � , _.,., <br /> Z <br /> APR f 0 <br /> Q ' <br /> 15- Special Handling Instructions and Additional Information <br /> LU <br /> APPROPRIATE PROTECTIVE CLOTHING AND RESPIRATOR <br /> I <br /> . ia +s. <br /> U <br /> _ GENERATOR'S CERTIFICATION: 1 hereby derlarg that the contents of this consignment are tally and ar-curaleiy described above by proper shippinq name ! ] <br /> -f and aro classified,pecked,marked,end labeled.and ern in qll rasti alr in proven condition for transport by hiqhwey according to applicable international and <br /> 4. national government regulations. f <br /> tt 11 ert <br /> 1 am a large quantity generator.I clfy that 1 hnve A program in place to reduce the volume and toxicity of Waite generated to the degree I have determined <br /> q to be economienny practicable and that t have selected the practicable method of treatment,storage,or disposal current! i <br /> present and future threat to human hgaith And th-envirommnnh OR. if I Am a smn11 quantityY available tome which minimizes the <br /> U generation and select the best wnsfe mannoemeM method ihnt fs AvAilnble to mend that Ig can afford!have made a peed faith effort to minimize my waste <br /> Z <br /> W Printed/Typed Name <br /> U Signature <br /> Month Day Year <br /> rr f: <br /> z T 17. Transporter 1 Acknowledgement of Recpipt of Matertats r <br /> w <br /> R <br /> 4 A Printed/Typed Name t <br /> N Sig rte I Month Day Year <br /> MM)ND L. J I NEJv,Ez <br /> ° P 0 22 9 0 <br /> •L <br /> ,9JA Transporter 2 Acknowledgement at Rocpipt of M.1—min <br /> n <br /> UPrinted/Typed Name ipnahfr> <br /> Month Day Year <br /> ' <br /> Discrepancy indication Spnce <br /> Facility Owner or Onerator Cortiri n of r^e^_ipt Ci++. ardOtes mafnrietc COQ^r^d by this mgmfe t e s oxcent as noted in Item t... <br /> y Printed Ty ams Sion at urg Month Day yenr I <br /> DH 11022 A(s:rt8) D �t Wri _ e{pw This Line <br /> EPA 8700-22 <br /> (Aev.9.08)Previous editions Are obsolete. 'r'/hrt�• 15DF .,ENO I$ t01aY TO DOHS WITHIN 30 DAPI <br /> T'.. ..J. !Sax 3000, 3aCrnm9!nf0. CA 95812 <br />