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Sime el.Coiilornio—En'roninq of Rolect;on Apeney <br /> 'm Approved OAtB' .2e1� 039(Expire 9.30941 See Instructions on back Of pane 6. Depart-aM of Toxic Substam"Ceritror <br /> ow print or type. form 1 signed I"use on el fe(12,okch)7Pe r <br /> Socromersso,Cotilomlo <br /> 1. �otor's US EPA 10 No. MOAifesl Document No. 2. Page I Information in the shaded areas <br /> W TE MANIFEST <br /> U IFQ!M HAZARDOUS is not required by Federal law. <br /> C of <br /> 3. c Normo cs sd Mailing Address - <br /> CONCRETE INC. _ <br /> 149 S. Stanislaus, Stockton, CA 95206 I ' <br /> .' t. c.enerotoes Pham. (2091 983-6565 <br /> } S. Transporter 1 Company Name 6. US EPA ID Nvmber <br /> NOR CAL OIL CAD 9 $ 2 4 1 7 2 5 5 7 ` 2p � '~ •x: <br /> 7. Transporter 2 Company Name 8. US EPA 10 Number "+T oifor~3;IC1 <br /> .. <br /> 9. Designated FociPty Name and Site Address 10, US EPA ID Number Ci'S►utdi, "17y( I <br />)` REFINERIES SERVICE <br /> 13331 N. Hwy 33 Y. <br /> Ft -4 11616 71 <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and 1D Numbed 12. Containers 13. Total 14, Unil <br /> ��qq 11 <br /> No. T e Quant WI/Vol •„ mF]a <br />�_ NON-RCRA HAZARDOUS WASTE LIQUID <br />)p (WATER & OILN) 01011 T IT G <br /> -07 E b . r,r <br /> EPIC f. <br /> A <br /> C. Tc <br /> R ,. <br /> �la1e{iafi'}LiifsB'A <br /> 0 'r L•':+eS X35"i'S)1 s �rQ'�aaCs a►. OfiC�t7�ed�1fSOVtl <br /> ( 13. Special Handling Instructions and Additional Information maim Mllm= <br /> Q APPROPRIATE PROTECTIVE CLOTHING - <br /> 7= "EMERGENCY CONTACT: (209') 667-6692" <br /> SEE E.R.G, PAGE 31 <br /> 16. GENERATOR'S CERTIFICATION, I hereby declare thcit the conlenh of the consignment are fully and accurately described above by proper shipping name and are closiditd, <br /> r_ packed,marked,and labeled,and are in all respech iri proper condition for transport by'highway according to applicable federal,slate and international lanes. <br /> C' <br /> It t am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> a economically procticablt and that I have selected the practicable method of treatment,storage, or disposal currently avoilablt to me which minimizes the present and future <br /> in threat to human health and the environmentr OR, if i am a small quantity generator,1 have made a good faith effort to minimize my waste generation and selW the bast <br /> n woste mono einem method that is available to me and that i can afford. <br /> G Printed/Typed Name dr i n Inorpe agent tosi, tui AAorrth Day Year <br /> U IF Concrete Inc. 0 4 1 1 9 <br /> Z t 17. Trons offer I Acknowledgement of Recti t of Materials <br /> w eo <br /> Printed/Typed Name ay <br /> C r , C? Signature Month D year <br /> U. <br /> o <br /> 18. Transporter 2 Acknowled ement of Recei t of Materials <br /> ur i Printed/Typed Noma <br /> v- 1 wre Month Day your <br /> C e <br /> u 19, (%xreparscy Indication Space <br /> V F <br /> w <br /> 1 20. Fade C>w+ner or O rotor Cert Fic ltion of recei t of hatardays mM.A.t,covered b this manifest except at noted in Nem 19. <br /> TPrinled/TytstdName Signature. g Marsch Day Year <br /> DO NOT WRITE BELOW THIS LINE. IF <br /> G"C B022A (7/92) Whiter TSOF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> L 6700.-'22 Tor P.O. Box 3000, Sacramento, CA 95812 , <br />