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of 7y f i <br />State of California—Environmental Protection Agency <br />Form Approved 4MB No. 2056-0039 (F,zpires 9-30-99) <br />R <br />p <br />- - <br />See Instructions On back b. <br />eI! '-°`, <br />Please print or type: form designed for use on elite 112 -pitch) typewriter. <br />page <br />,_ < <br />Deportment o Toxic Substances Coat <br />Sacrament, California = <br />11!;�;V -S 2�ZP <br />UNIFORM HAZARDOUS'__. <br />V4. <br />g <br />1. Generator's US EPA ID No. Manifest Document No <br />2. Pagel <br />Information in the shaded areas .4 <br />WASTE MANIFEST <br />4, <br />f1 <br />) 7 <br />1 1 <br />of 1 <br />is not required by Federal law. <br />a <br />3. Generator's Name and Mailing Address I \ <br />ATERLOO ARCO — PAUL S I DHU <br />0 3032 E. WATERLOO RD., STOCKTON, CA 95205 <br />LO <br />4. Generator's Phone 1209 )466--381 b <br />CV 5. Transporter 1 Company Name 6. US EPA ID Number - <br />aCo 0P CAL OIL C AD 9 82 4 17 ? 55 <br />O <br />O <br />R <br />p <br />Printed/Typed Name <br />CP <br />bay <br />7. an Transporter 2 Com Name <br />p Company 8. US EPA t0 Number <br />J <br />Q <br />11!;�;V -S 2�ZP <br />V4. <br />g <br />U- <br />Desi noted Facility Nome and Site Address 10. US EPA !D Number <br />I NDUgTR I AL SERVICE OIL CO. <br />LO700 <br />S. SOTO ST. <br />Alft^ Cie <br />Ve,jJ <br />SignatureMonth <br />LOS ANGELES, ECA. 900213 fa 9 <br />Q <br />V <br />E <br />R <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />s <br />V <br />19. Discrepancy Indication Space <br />� <br />Z <br />ODEE <br />HAZARDOUS WASTE LIQUID <br />3 <br />G <br />ZION—RCRA <br />WATER & SL1.1DGE ) <br />o <br />E <br />N <br />b <br />00 <br />E <br />v <br />v <br />R <br />A <br />C <br />6 <br />w <br />T <br />YPrinted/Typed <br />R <br />Month Day Yearf <br />cc <br />d <br />Z <br />w <br />V <br />1rt <br />DO NOT WRITE ELOW IS LINE. <br />U.1 <br />V) <br />DISC 00-22 (4/97) <br />.. <br />Z <br />0 <br />V1 <br />W <br />04Q <br />Z <br />12. Containers 13. Total 14. Unit <br />No. Type Quantity Wt/Vol <br />s <br />0I T In 1! Intl n i - r <br />0 15. Special Handling Instructions and Additional Information r» i <br />Q PPROPR. I ATE PROTECTIVE CLOTHING <br />Z 'EMERGENCY GONTAC•T: (?09)54 1-9 1 451& - '< <br />= EE L.R.G. 1:1 <br />16. GENERATOR'S CERTIFICATION: I hereby declare thahthe contents of this consignment are fully and accurately described above by proper ship ing name and are classified od <br />Vmarked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and notionoPgovernment regulations. 4 +r <br />—' If I am a large quantity generator, I certify that Chave 'a program m place to reduce the volume and toxicity of waste generated to the degree 1, have determined to be economically <br />RZ prao-able cr-d that 1 q s� i•.a� r : r.act-,able mr±h_ q k+ .r:. + pc _.! f ... p. ' h E . <br />d_ nt, c, re, ..r dis sd. c: rr,::W a� o me :.c.. _e_ ,f a 3:;7 act :u. Lica. is f:.mac <br />and the environment; OR, if I am a small quantity generator, I Save made a good faith effort to minimize my waste generation and select the best waste %nonagement method that is <br />available to me and that I can afford., <br />} Printed/Typed Name s �r Signature r-1-) tj Month Day <br />w T 17 Trans ortef 1 Acknowled ement of kecei t of Materials <br />w <br />R <br />p <br />Printed/Typed Name <br />Signature <br />bay <br />w <br />R <br />S <br />11!;�;V -S 2�ZP <br />�Mgonfh <br />if f <br />U- <br />0 <br />18. Trans iter 2 Ac nowled emeN of Receipt of Materials <br />TPrinted/Typed <br />Nome <br />SignatureMonth <br />Day Year <br />LU <br />N <br />Q <br />E <br />R <br />s <br />V <br />19. Discrepancy Indication Space <br />� <br />Z <br />F <br />_ <br />A <br />C <br />/r <br />L <br />» <br />1 <br />20. Foci li Owner or Operator Certification of receipt of hazardous ata' Is covered ism es .—f as noted in Item 19. <br />YPrinted/Typed <br />Name Si1..jgnatur <br />Month Day Yearf <br />' <br />YZ �., <br />1rt <br />DO NOT WRITE ELOW IS LINE. <br />/ <br />f <br />DISC 00-22 (4/97) <br />EPA 87700—Green. TRANSPORTER RETAINS <br />