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Stale" a ' yironmental Protection Agency "` See Instrt�ctl®ns On back O @ 6. Deportment`of Toxic Substances Control <br />For o.2050 -=? (Expires 9-30-94) " Sacramento, California <br />Pletye` Form designed for use on elite (12 -pitch) 6*,vriter. <br />1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br />UNIF®RM°�`IMACARDOI U a 33 0 �• of is not required"by Federal law. <br />WASTE MANIF69 <br />3. Generato <br /># <br />'s' Name and Mailing ' ress til <br />o 835 S TOCKT N'$ <br />In <br />iDI �' LO OX BBB CI A 95240 <br />rl�4. Generator's Phone { =0C ` 334-3352 <br />6. US EPA ID Number <br />5. Transporter 1 Company Name <br />OP SAF' TY—KL LEN CORP. I �+ O� � <br />J 7. Transporter 2 Company Name <br />8. US EPA ID Number <br />9. Desi noted Facility a an dress 10. S EP Nu r <br />50 SALIDA BLVD. <br />?� 000.6-13969, <br />tLID <br />Q 12. Containers 13. Total 14. Unit <br />11. US DOT Description(including Proper Shipping Name, Hazard Class, and ID Number) Quantit Wt/Vol <br />79 <br />WASTE SMI T I BIL -E LIQUID, N. Q: S- �t <br />3 G MINERAL SPIR NAl993' PGI 11 (I�00I � l <br />(Rte#27) t <br />E b. RG WASTE COMPOUNDSi �:1.E0�s3ING LIQUIDI3P1 <br />N R (MR'�#` OETHAINDLAr!P"I N B NA i? PONT <br />I I <br />A (DO )BERG#60) <br />00 <br />T C <br />ca R <br />W .. <br />Z d. <br />to <br />U <br />LU <br />N <br />Z <br />Q <br />a <br />N <br />W <° <br />"' OG <br />Q <br />® 15. 5 ecial Handl* Instructions and Additional Information <br />a} <br />P fM# _'RG IPM" RIESP#708-8 —466 � �iH <br />a <br />Z r� D: <br />LU BKDDT# A: <br />f- <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 packed, marked, and labeled, and are in all respects in proper condition for transport by highway according ro applicable federal, state and internationaltaws. <br />C7 , <br />If I am a large quantity generator, I certify. that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree 1 hove determined to 6e <br />aeconomically 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 />N threat to Kumon heahh and the environment; OR, ff I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the Best <br />j - waste management method that is available to me and that I can afford. Month Day ear <br />'( (� Printed/Typed Name Signature <br />U r 17. Trons rter 1 Acknowled ement of Recei t of Materials <br />j Z Month Day f ear <br />W R Signature [! <br />N. Printed/T ped N m / !/ <br />Uj <br />0 18. Transporter 2 Ackn iedgement of Receipt of Materials [Month�Day�YfrWTPrinted/Typed Name Signature <br />O <br />R <br />w 19. Discrepancy Indication Space _. <br />i <br />Q F _ <br />U 'A <br />Z C <br />1 <br />l 20. Facil' Owner or Operator Certification of receipt of hazardous materials covered b this manifest exce t as noted in Item 19. Month Day Year <br />T Printed/Typed Name Signature <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DISC 8022A (7/92) Yellow: GENERATOR RETAINS <br />EPA 8700-22 <br />