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State gf Ca nvironmental Protection Agency <br />F= roved OMB tJo. 2050-0039.(Expires 9-30-94)� See Instruction's"011 baCIC Ame_ 6. .Deportment of Toxic Substances Control <br />" Please print. N. type.- Form designed for use on elite (12p;tch) typewriter. - Sacramento, California <br />UNIFORM HAZARDOUS <br />Generators US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas' <br />WASTE MANIFEST <br />I&D ` 362 <br />C D 03P <br />is not required by Federal law. <br />I <br />of <br />3. Generators Name and Mailing Address PACIFIC C OA 5T P <br />® <br />835 S STOCKTON...ST <br />Pik BOX : 88C) <br />LOD I CA 95240 <br />04 Ln <br />4. Generator's Phone 09) 334-3352 <br />OD <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />00 <br />SAFETY- LE AF CORP. 0 0 () S <br />-Jr <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />9. Designated Facil' Name and Site Address 10. US er <br />P I N <br />SAFETY' -I+�iL Elrt CORP.?-� <br />S 30 SALIDA BLVD <br />SAL I DA •r CA 95368 CAT 000613968 <br />Q <br />11. US DOT. 12' Containers 13. ,Total 14. Univ <br />ri tion (mdudin Pro er ShiPPm Name, Hazard Class, and ID Number) <br />No. Type Quantity Wt/Vol <br />t- <br />1QASTE" COMBUSTIBLE LIGUIDs N. O. S. DM <br />E L SPIRITS) NA193 PGIII (D001)G ("ii:► <br />C <br />E <br />(ERG#27) ) ! <br />ao <br />N <br />b <br />N <br />R.' <br />W <br />T <br />C. <br />ce <br />R' <br />;w <br />Z <br />d <br />LU <br />U <br />LU <br />rA <br />Z <br />' <br />O <br />a <br />N <br />w <br />W <br />- <br />" <br />J <br />Z <br />15. _Special Handling Instruction and Additional Information <br />EMERGENCY RESP#'r 08-geS-~°4660 24HR � <br />Z <br />_ <br />_ <br />SKDOT# A: 501 D: C: D: <br />k- <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 />U <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 />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 />threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />waste management method that is available to me and that 1 can afford. <br />0Printed/TPrinted/Typed <br />Name <br />Si nature / <br />Month Day, Year <br />U <br />ml"eC4 a' '�V i <br />G <br />6 <br />Z <br />r <br />1 . Trans rter 1 Acknowledgement of Receipt of Materials <br />0 <br />N <br />Printed/Typed Nam <br />Signature - <br />Month Day Year <br />Ix <br />LU <br />S <br />-. <br />1 <br />p <br />0 <br />18. Trans rter 2 Acknowledgement of Receipt of Materials <br />w <br />y <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />U. <br />0 <br />tr <br />_ <br />N <br />19. Discrepancy Indication Space <br />U <br />p <br />Z <br />E <br />1 <br />20. Facil' Owner or rotor Certification of recei t of hazardous materials <br />covered b this manifest except as noted in Item 19. <br />T <br />Printed%Typed Name <br />Signature <br />Month Day Year <br />Y" <br />DO NOT WRITE BELOW THIS LINE. <br />t F 7° <br />DTSC 8022A (7/92) <br />C 4.0 GEN RA R RETAINS <br />EPA 8700-22 <br />