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State of Colifornio—Environmental Protection Agency <br />Form Appoved OMB No. 2050-0039 (Expires 9-30-96) See Instructions on back of6 <br />Please print or type, ' Form designed for use on elite (12-pifch) A, 1W <br />0. <br />(A <br />Ix <br />0 <br />U <br />Z <br />LU <br />0 <br />W <br />to <br />:E <br />Uj <br />U_ <br />0 <br />Uj <br />U <br />ti. <br />artment o T Su stances Control <br />Sacramento, California <br />DO NOT VACPACITE BELOW THIS LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 <br />DTSC 8022A (1/95) To: P.O. Box 3000, Sacramento, CA 95812 <br />or's U� E S, 3 . Manifest Document No. 2. Page I � <br />UNIFORM HAZARDOUS e <br />17 a ?a <br />Information in the shaded areas <br />is not required by Federal low. <br />WASTE MANIFEST <br />of <br />3. Generator's Nome and Mailing Address <br />A. State Manifest Document Number <br />11'4 G — J-3 L DG. S -- 4 SHAfF.'1F--E_ r­AI__'-I1L!7T' <br />95673108 <br />STOCIP-:70N, CA 95j*27­3f: <br />B. State Generator's ID <br />4. Generator's Phone:ZOD) 0%827­27,C',D4 <br />5. Transporter I Company Name 6. US EPA ID Number <br />4 <br />--:AL <br />C. State Trartsporter's ID <br />/76/ <br />T 3 <br />,40[--.. i OIL I: AD 3 t 17 2 55 <br />D. Trompormr-s Phone <br />0 9 6-6 7 9 i2 <br />7. Trans orter 2 Company Name 1, IS IPA ID Number <br />E. State Transporter's ID <br />� 2 0,4 /_0 IL 4A -P . I <br />F. Transporter's Ph:—Fmf) <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's1, <br />PATTEF.S011-4, INC. <br />le�RDIPIU 11 k, <br />1 33333-3 1 kv-4+01IRTH HWY. 373) <br />H. FaIctilitys Phone , 1 1 <br />—ATTERSON, CA 953-63' I AP SP 111 Op 171 2P <br />Soo cZ -7 q <br />IC 10 1 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />Quant -y <br />WI/Vol <br />1. Waste Number <br />'HI*'1Z?A1_�.'D1e_1kjS 100 Pi 3) T E� L 1 Q. U I D <br />Stpte, <br />G <br />'WP TEr.o r" U 0, E <br />0 C" <br />13 <br />EPA/Other <br />E <br />11L <br />J2, <br />7 <br />N <br />b. <br />State <br />E <br />EPA/Other <br />R <br />A <br />T <br />C. <br />state <br />0 <br />EPA/Other <br />R <br />d. <br />Statee <br />EPA/Other: <br />J. Additional Descriptions for Materio!s'Usted Above <br />K. Handling Codes for Wastes <br />Listed Above <br />TANK BOTTOM WASTE, <br />a. <br />R I NSATE <br />'d. <br />15. Special Handling Instructions and Additional Information <br />A i &:. PPROPRIATE IF'ROTIECIFILVE CLOTHING JOB SITE: <br />" E M E F.'13 E INIC Y C: C NIT ""' C:;"; .Z, o 9 :) G 677 - G G %3 2 11 <br />c SEE E. F. 1`3. Sa <br />BLDG. 647 <br />I— f__ <br />SHARPE DEPOT, LATHRC <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br />packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to <br />applicable international and national government regulations. <br />If I am a large quantity generator, I 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 />threat to human health and the environment; OR, if I am asmall quantityI 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 I can afford. 4 <br />Printed/D3WA,Name <br />Sig&UX <br />Month - Day Year <br />T <br />17. TrogspoIrter I Acknowled ement of Receipt of Materials <br />A <br />Printed/Typed Name <br />Signature C-1 <br />CX <br />Mont Day -Year r <br />PS <br />— JOE PUETT <br />�1 <br />0 <br />18. Trans po r 2 Acknowledgement t of, Materials <br />ItI- <br />T <br />E <br />It <br />Printed/Typed Name <br />afRecei <br />om M r U _ <br />ture <br />Month Day Year <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous malt <br />of$ cov this manifest excesAjas Doted in Item 19. <br />T <br />Printed/ Namet7� <br />U <br />Month Day Year <br />Y <br />�� C-11kLLIA <br />I(A <br />DO NOT VACPACITE BELOW THIS LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 <br />DTSC 8022A (1/95) To: P.O. Box 3000, Sacramento, CA 95812 <br />