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State of Californio—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-94) See Iltstructions on bock O Po6. Department of Toxic Substances Control <br />i leash pri Form designed for use on elite (12 -pitch) typewriter, Sacramento, California <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Document No. <br />CAI 063 <br />2. Page 1 <br />1 <br />Information irk the shaded areas <br />is not required by Federal law. <br />WASTE MANIFEST <br />of <br />3. Generator's Nameand.Maiiliing Addre.ss PACIFIC UA <br />0 <br />. . <br />835S. g�0nAT0N-'ST <br />PO Box Sao <br />LORI CA 95240 <br />h <br />4. Generator's Phone (e'.109 4-335 <br />W <br />6 <br />5. Transporter 1 Company Name 6. US EPA ID Ptu#nber <br />OP <br />90 0 <br />SAFETY—KLEEN CORP. ILD 984908202 <br />1 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />Q <br />Voo ,; <br />Q <br />Z <br />9. Designated Fppu`lity T ang i ddress 10. S I Ny�f�er <br />SAI"E_aY­ tkL i� .0 � <br />0 <br />5050 '43AL I YEA BI., Vt *ate <br />SAL I DA A 95368 CAT 13968 <br />_ <br />a <br />U <br />I Z <br />12. Containers 13. Total 14. Unit <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />No. T Quantity Wt/Vol <br />2 <br />ey t= <br />a. � <br />`-'C JASTE C OMBVS " BL.E L.I QU I D,' N O. S. DM <br />3 <br />G <br />un TM'T R L EEM NAPHTHA MA1993 00I I (ii00 ) 1 . <br />' <br />E, <br />d RQ#2 D 6.7 LBS./GAL,l <br />do <br />N <br />b• <br />ao <br />B' <br />R <br />00 <br />C. <br />txLLJ <br />Z <br />d. <br />U <br />LU <br />Z <br />O <br />CL <br />N <br />W <br />J <br />Q=11 <br />IN <br />Z <br />15. ecia(Handling Instructions and A dkional f rmatio qq „ <br />G�:�+CY R SP /61 S C9 ?�} ^?sem <br />Q <br />Z <br />LU <br />.� l 'V d.. E;A , C � a ; <br />$1'1�,a T��346 ^y <br />. .. . <br />r <br />16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the consignment are fully and accurately described above by proper shippjdg name and are classified, <br />Q <br />p P� • P pe P Y 9 aY n9 PP � , <br />packed, marked, and labeled, and are in all res in proper condition for transport b highway according to applicable federal, state and international laws. <br />If I am a large quantity generator, I certify that I have- d' program in place,.to reduce the volume and toxicity of. waste generated to the degree I have determined to be <br />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future <br />CL <br />threat to human health and the environment; OR, if jam a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />waste mono ement method that is available to me and that I can afford. <br />-'Von <br />O <br />p i d/Typed Na ate:'` <br />T <br />re <br />n/ % <br />+(dr eas <br />: ✓l <br />G j F <br />U <br />It <br />17. -Trans -Transporter 1 Acknowled'ementrof Recei ,of Materials <br />ud <br />q <br />Printed/Typed Nams ¢¢ ° t <br />j <br />Signatuece j <br />« <br />MRnth t,., <br />W._, <br />S <br />F p,� <br />r ,., r : <br />- -. <br />W <br />0 <br />18. Trans" rter 2'Acknowled ement of Receiptof Materials <br />R <br />Signature > <br />Month Day Year <br />LL <br />T <br />Printed/Typed Name <br />w <br />19. Discrepancy Indication Space <br />to <br />Q <br />F <br />, <br />U <br />A <br />Z <br />_ <br />C <br />1 <br />I <br />20: Facility Owner or Operator Certification of receipt of hazardous materials <br />covered by this manifest except as noted in Item 19. <br />T <br />T <br />Signature <br />Month _Day YearT, <br />rpedName _ <br />1 <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (7/92) <br />EPA 8700-22 Yellowy: GENERATOR RETAINS <br />