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State of California -Environmental Protection Agegcy r- © ' . S , <br />Fo ove OMB No. 2050-0039 (Expires 9-36-94) - _ S@@InS$rtrC$10tts Ott, bdClC dlj@ b Department of. Toxic Substances Control <br />Please. print or type. 'Form designed for use on elite (12pitch) typewriter. * Sacramento, California <br />w' 1 • Generators US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br />UNIFORM HAZARDOUS <br />CAO 063036776 pl�� ! is not required by Federal law. <br />WASTE MANIFEST of <br />3. Generafbr s Name and Mailing Address <br />0 835 8TQCKTON .8T <br />to PO BOX -880 <br />to L00I CA 95240 <br />N <br />W)4. Generator's Phone 2091334-3352 <br />00 <br />5. Transporter 1 Company Name 6. US EPA ID Number :. <br />oa SAFETY -'KLEEN CORP: ILD 0-51060408 <br />r— <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />Q <br />jAIp <br />U <br />Q a1� �� F 1`I'djp Odd ress 10 <br />�gS P Nyq�ber <br />BAL 1 DA ' $L•VD. <br />LL <br />SALIVA' CA 9536e CAT 000613968, <br />J <br />Q <br />U 12. Containers 13. Total 14. UniT <br />Z 11. US DOT Description (including Proper Shipping Name Hazard Class, and ID Number) <br />No Type Quantity.Wt/Vol <br />sa.WA�3TE.. CONBUSTI LE L.IQUlD #�! <br />3 G (P)ETROL.EU NAPHTH �' A19 PGI I.f , o! <br />cERG*227) <br />.N b' Cp (A f <br />aaE,� <br />06 <br />MT �- <br />R <br />w <br />Z cl <br />V <br />LU <br />U) ` <br />Z 'sr <br />0 <br />a <br />to <br />LU <br />Z 15, S ecial Hand i (n ion rma 'o <br />JE 241HR <br />e <br />Z <br />W SKD0T# A: <br />50! . � {pip C:1Li, . <br />x 9017)1 7 �3t <br />�. <br />J 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 packed, rtlarked,' and labeled, and are in all respects in proper condition for transport by highway'according to applicable federal, state and international laws. <br />U t <br />If I am a large'quantity generator, 1 certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I Have determined to be; <br />J economically practicable and that I have selecied the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future <br />n threat to human' health and the environment; bR, ff 1 am' a small quantity generator, I have made a good faith effort to minimize my waste generation and select The best <br />to <br />waste' management method that is available to me and that I can afford. <br />® d/Typed Name' re _ nth Day ,Xe1sr' <br />r <br />V T 17. Transporter 1 Acknowledgement of Receipt of Materials <br />W e Si nature f Day <br />ear <br />A- Printed T Name g 1 <br />(� A <br />w S p €lAt <br />P., <br />0 18. Transporter 2 Acknowled ement of Recei t of Materials =� <br />tY T Printed/Typed Name' Signature Day Year <br />W B� :.--- <br />0 it <br /><n 19. Discrepancy Indication Space ~ <br />U /► a <br />Z <br />j • <br />1 20. FacilityOwner or rotor Certification of recei t of hazardous materials covered b' this mani est xce t as noted in Item 19. <br />T Printed/Typed Name Signature <br />- Month ..Day, Year <br />Y <br />DO NOT WRITE BELOW HIS UNE.. <br />DTSC 8022A (7/92) ' Yellow: GENERATOR RETAINS <br />EPA 8700-•-22 <br />