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State of California enc <br />y <br />Form Approved O s 9-30.99) See Instructions on back of =e 6. Department of Toxic Substances Control <br />Please print or typ on elite (12 -pitch) Ater. - Sacramento. California <br />0 <br />to <br />uO <br />N <br />00 <br />00 <br />0 <br />0 <br />00 <br />N <br />0 <br />w <br />00 <br />v <br />N <br />v <br />0 <br />0 <br />ao <br />W <br />w <br />I— <br />Z <br />w <br />V <br />w <br />V) <br />LU <br />cleQ <br />Z <br />O <br />Q <br />Z <br />w <br />J_ <br />Q <br />V <br />J <br />a <br />V) <br />0c <br />0 <br />} <br />V <br />z <br />w <br />oe <br />Uj <br />w <br />w <br />U- <br />0 O <br />w <br />N <br />Q <br />V <br />I� <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (4/97)° <br />EPA 8700-22 <br />Yellow: GENERATOR RETAINS <br />2. Page 1 <br />RDOUS 1 . ` �e^erator's US EPA ID No. Manifest Document No. Information in the shaded areas <br />is not required by Federal law. <br />IFE§T f 1 I I _ (1f .: <br />of I <br />3 Generator's Name and Mailing AddressPaie <br />ESI ALON MINI MART <br />1+nf61, rCrt1^einF� a° ro� , <br />1{1'9.7 YOSEMITE. ESCALON, CA 95320 <br />SPIN <br />4. Generator's Phone (2 FW 9"99S5 <br />V, �"- <br />5y. <br />S. Transporter 1 Company Name 6. US EPA ID Number <br />NOR CAL OIL. C A LS 'D Fi , --k <br />55 <br />Wr M� <br />€` <br />.: <br />7. Transporter 2 Company Name 8. US EPA ID Number- <br />uT <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />I._ <br />OMEN I CLEAN. INC. <br />� � k <br />570 ALMOND DR. <br />g <br />S I f_..4.1F* f=' SE= P T NGS m I°`• V 89-129 N r� ! '� '�' ° '::' � 3 ' <br />P <br />11, US DOT Description )including Proper Shipping Name, Hazard Class, and ID Number) <br />nt <br />12. Coainers 13. Total <br />14 Unit <br />s a <br />No. Type Quantity <br />Wt/Vol <br />�et,gmb��.l*»€, <br />NOft.._°F,'f rr(.) F-1 izn- rnO S WASTE L_IcuID <br />�� <br />(t TATER SL.t 1ID E '1 <br />I't <br />� 1 1. <br />r I <br />I_ <br />E A> <br />E <br />N <br />6.tcrt <br />�a <br />� n <br />E <br />RAc�� <br />A <br />T <br />'21111,171 M'fflel <br />O <br />fides <br />IF <br />d <br />1 :Ad ltlbpol i3AgeCf}'1 fOs fei' Ali�r��x�i �i� ,.°. d➢I r � .�, <br />� � : r�.�r � "� � <br />15. Special Handling Instructions and Additional Information <br />APPROPRIATE PROTECTIVE CLOTHING <br />"EMERGENC:Y CONTF'f_.T: Q09-4)541-914511 . <br />EE E. P. 6. 171 <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 />marked, 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 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 economically <br />and that I have the treatment, disposal to the future threat human health <br />practicable selected practicable method o{ storage, or currently available ane which minimizes present and to <br />and the environment; OR, if I am a small quantity generator, I hove 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 />P inted/ yped I�bme Cv mY / �r,. <br />Signaturer <br />117�� -t ^ Y S' <br />Month Day ear <br />TR <br />17. runs orter 1 Acknowledgement of Recei t of Materials <br />d <br />R�jv�J <br />Printed/Typed Nafts <br />"Signature <br />Month Day Year <br />5 <br />0 <br />18. Trans rter 2 Acknowled ement of Receipt of Materials <br />TPrinted/Typed <br />Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />I <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Doy Year <br />v <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (4/97)° <br />EPA 8700-22 <br />Yellow: GENERATOR RETAINS <br />