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State of California—Environmedt<dl Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back 04. Department of Toxic Substances Control <br />Please print or type. Form designed for use on elite (12 -pitcrater. - , z 't Sacramento, California <br />AL <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />Ar. i. 8, 7 1 <br />of A <br />is not required by Federal law. <br />3. Generator's Name and Mailing Address <br />WATERLOO ARCO — PAUL 5I DHU <br />A. State Manifest Document Number <br />" <br />3032 E. WATERLOO RD., STOCKTON, CA 95205 <br />B. State Ge,—olIto'!s ID II I I I <br />4. Generator's Phone ('d"og )466-581 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. Statc T,ansporte,'s ID <br />OR CAL OIL C AD S 82 4 17 2 5s• <br />-- <br />D- lratsporter's..Phone <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Trar porter's II'' <br />F. Transporter', Phone - <br />F ci' Na t ess 10. US EPA ID Number <br />OIL Co. <br />G State Facility s It <br />1700 S. SOTO ST. <br />I� <br />C: )t)'_ 0 7 s , <br />0S ANGELES, A. S C: A S t: <br />H Foci ora <br />11. US DOT Description linduding Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/vol <br />4 <br />':1. Waste Number � <br />No. <br />Type <br />NON—RCRA HAZARDOUS WASTE LIQUID <br />watate <br />Ca <br />(WATT R & SLUDGE) <br />0 01 <br />T i <br />! <br />EPArOrhe <br />E <br />N <br />b. <br />State <br />REPA/Other <br />A <br />T <br />C. <br />— -- — <br />Srcire� <br />EPA/Other <br />R <br />r-._ <br />d. <br />stare <br />EPA/Other <br />)..Additional Descriptions for Materials Listed Above <br />K. Handling Codes forWastes Listed Above <br />moft <br />01 b <br />15. Special Handling Instructions and Additional Information <br />PPROPRIATE PROTECTIVE CLOTHING <br />"EMERGENCY CONTACT : ( 209) 541- 914511 <br />EE E.R.G. 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, l certify that I have a proggram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economical)y <br />and that I have the treatment, disposal minimizes the future threat to human health <br />practicable selected practicable method o storage, or currently available to me which present and <br />and the environment; O , ' I am a small quantity,.generat I }rave made a good faith effort to minimize my waste generation and select the best waste management method that is <br />available to me and th c afford. <br />V <br />Printed/Typed Name <br />Signature l: <br />"X <br />Mont)} Day <br />T <br />17. Trans orter 1 Acknowledgement of Receipt of Materials <br />R <br />A <br />Printed/Typed Namfie/ p <br />bfgr�}oture <br />Mont gJDay%� Year <br />S <br />P <br />0 <br />18. Transporter 2 Acknowledgement ofReceipt of Materials <br />TPrinted/Typed <br />Name'nature <br />Month Day Year <br />E <br />R <br />19,r Discrepancy Indication Space <br />_. <br />F <br />._ <br />A <br />C <br />1 <br />L <br />1 <br />20. Facility er O er for rtificat on cei t of hazardous materials covere ' t m to pt oted in Item 19. <br />T <br />Printed/Typ <br />Signal <br />Y <br />w DO IOi WR1T"ELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />DTSC 8022A (4/97) (Generators who submit hazardous waste for transport out-of-state, <br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />