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State of Californio--Environmental Protection Agency _! <br />form-Appro OMB No. 2050-0039 (Expires 9-3094) See Instructions on back O age 6. Department of Toxic Substances Control <br />"Alva < r type.:' Form designed for use on elite (12-pitch) typewriter. . .,. Sacramento, California <br />4^ +` <br />1. Generators US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />r <br />,UNIFORM HAZARDOUS ' <br />1313 <br />CAD 063036776of <br />is not required by Federal law. <br />, <br />s WASTE MANIFEST <br />3. Generator's Name and Mailing Address 5 <br />o <br />3 T,,QCKTQN .5T° <br />in <br />I] C? BOX'880 <br />LLD I C<A V73240 <br />N <br />4. Generator's Phone ( 209 3$41-3352 <br />00 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />OP <br />SAFIET '^>-KLEEW€ RP. il.. 051060408 <br />_ <br />^. <br />t <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />Q <br />V <br />' Q <br />Z <br />9. Desi$naf q Facil' N ad �5. ass 10. U P I mbar <br />8 3 -1 dV [�f IBt d"�. i1 <br />a <br />p <br />5050 SALIDA BLVD. <br />SALIDA . CA 95368 CAT 000613968 <br />i <br />Q <br />Unit' k <br />12. Containers <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) No. <br />U <br />Z <br />13. Total 14. <br />Type Quantity Wt/Vol,` <br />st— <br />3 <br />a. WASTE COMUSTIBLE LIQUID, N. 0. S. DM� <br />(PETROLEUM NA H f A )1�A 199 PO I (DO0 ) <br />G <br />A01 <br />�i <br />E <br />(ERG#27) <br />c00o <br />6 b. <br />G WASTE COIL OUND t C;L ANING LIQUID <br />(MONOETHANOLAMINE) NA1160 Ft O I I <br />R <br />(.x$00 )i( Q# 60 ) <br />T <br />c. <br />rY <br />R <br />LU <br />t— <br />�w <br />d <br />V <br />m <br />LU <br />Z <br />O <br />a <br />LU <br />in <br />E. E x' Ifil lel rgpt � al f 3 �o 6 i0 <br />F— <br />Q <br />. <br />Z. <br />W <br />SKDOT A: 501 566 C: ; <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br />Q <br />packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable federal, state and international laws. <br />y <br />V <br />.. <br />If I am a large quantity generator, 1 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 />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 />N <br />threat to human health and the environment; OR, if 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />management method that is available to me and that I can afford. <br />ad <br />-O Pped Name 3 <br />S' ature..,, r� / <br />Mont & y �^,reO <br />VT <br />17. Trans orter 1 Acknowled ement of Receipt of Materials <br />W <br />O <br />E <br />w <br />Printed7,14V <br />� X16 <br />Signature f} <br />u10 p f y,Year <br />f <br />UJ <br />5 <br />w <br />0 <br />18. Turns rter 2 Acknowled ement of Recei t of Material <br />Month Day. Year <br />T <br />Printed/Typed Name <br />SignatureU. <br />O <br />E <br />E <br />W <br />19. Discrepancy Indication Space <br />Q <br />F <br />U <br />Z_ <br />C' <br />Lr <br />I, <br />20. Facil' Owner or Operator Certification of receipt of hazardous materials <br />covered b this manifest exce t os noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature Month Day Year , <br />y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (7/92) <br />EPA 8700-22 Yellow: GENERATOR RETAINS <br />