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State ofCalifomia—Environmental Protection Agency <br /> Foran Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of ge 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pits rifer. Sacramento,California <br /> ° 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS � F-- ± is not required by Federal law. 5 <br /> WASTE MANIFEST A 2 ~ of <br /> 3. Generator's Name and Mailing Address *"^PRUI�.QA. State Manifest Document Nb <br /> � , ocumenNumber2379, ,� w <br /> ! rlV7 !J.L. jj0gSOCeL: <br /> rPAIM <br /> O . State Generator's ID <br /> to 4. Generator's Phone fJ'f ) � L o 9 L_p 05 <br /> C145. Transporter 1 Company Name 6. US EPA ID Number C. State.Transporters.ID Reserved.] <br /> OP �.�i`t��f;',d M V Ai t `ar "L g.' 0 1 e, A 1 06 0 ?i � f' � �� : -4 <br /> ^^ m D. Transporter's Phone + <br /> O <br /> C? 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter s:ID(Reserved.] <br /> J F. Transporters Phone a' <br /> Q <br /> 10. US EPA ID Number G. Sta ci '411? (f 0 0 1 9 0 8 <br /> Q 5MO CLAUS ROAD = : <br /> 0 RIVERBANK, CA,95367 C A - � 0 0 1 4 3 1 C H- Foci li " i `I <br /> J 12. Containers 13. Total 14. Unit _ <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) g <br /> V No. Type Quantity Wt/vol f Waste Number Nft <br /> Z "+ON $CRA HAZARDOUS WASTE:LIQUID State <br /> OILY WATER ) 00 1 T T � <br /> G EPA/OtheE <br /> O N b. ( State . <br /> 00 <br /> 00 E <br /> R EPA/Other <br /> CN <br /> A C State . <br /> O T <br /> 000 O <br /> R EPA/Other <br /> LU d. State <br /> t- <br /> Z <br /> w <br /> V EPA/Cither <br /> w <br /> ZJ. Additional Descriptions.for Materials Listed Above ° K. Handling Codes for Wastes Listed Above <br /> O OILY WATER a. I b.. <br /> CL <br /> w <br /> C, d. <br /> J <br /> Q <br /> Z 15. Special Handling Instructions and Additional Information <br /> a GLOVE <br /> Z <br /> EMERGENCY N PHONEZZM-667-8857 <br /> w <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,packed„_ <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantiy 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 economically <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> N 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 waste management method that is <br /> available to me and that I can afford. <br /> O <br /> �. If Printed/Typ Name Signature i Month Day Year <br /> 11-4 <br /> w N 17. runs otter 1 A-(<nowled ement o Recei t of Materials ',% <br /> LU A Printed/Typed Name Sigpature y Month Day Year <br /> Uj i S <br /> U- 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> O T Printed/Typed.Name Signature Month Day Year <br /> N E <br /> Q R <br /> tJ 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> 1 <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />