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State of Cahfornida Environmental Protection Agency ` r <br />Form Approvedq.MB'No, 2050-0039 (Sipire's 9-30-99) Sege fnsMUctions. <br />Wease print or type., Form designed forvrse on elite (12- writer," <br />a <br />UNIFORM HAZARDOUS'... 9. Generators US EPA ID No. - Manifest Documer <br />WASTE MANIFEST' 1 <br />:• <br />3. Generator's Name and Mailing Address `. <br />ATERL•GiQ ARCO — P'AUL. S i DHU <br />p 2 E. WATERLOO RD., STOCKTON, CA 95205 <br />209 1466-58 <br />lwntsam� <br />Socro6ento,,'Colif ornie <br />a..' 2.• Page 1 information in the shaded drew <br />is not required by Federal law: <br />14. Unit <br />0 15. Special Handling Instructions and Additional Information <br />aPIPPROPRIATE PROTECTIVE CLOTHING Y. , <br />Z `EMERGENCYCONTACT: (209)541--9145" <br />LU <br />EE E.R.8. 171 <br />Q16. 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 />U marked, and labeled, and are in all respects in proper condition for tronsport liy highway according to applicable international and national government regulations. " <br />If I am a large quantile generator, t certify that 11bave c program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be econoi <br />a+ prase able c +d !hat I rave set . , t. - . <mc?;^abls meth �„of trs r -at, 'r. -s, ^r d•• sa.ol curr::A, „ as s »J ;cL r. _ iha Prase: t .nj 'u!- �s . tc { nncr <br />and"the environment; OR, if I am a small quantity generator, I fiave made a goad faithreffort to minimize my waste generation and select the best wasto nanagement method <br />® available to me and that I can affnrd.P- <br />�} Printed/Typed Nome , Signature ( 1 Month D6p <br />W T 17. Trans rtef 1 Acknowled ement of Receipt of Materials <br />C7 R <br />W <br />N <br />Printed/Typed Name <br />-s <br />Signature <br />Month <br />i 5. Transporter I Company Name <br />6. US EPA I -D <br />Number7. <br />10P CAL �yy <br />2 .. <br />O0 <br />18. Trans rter 2 Ac nowled ement of Receipt of Materials <br />R <br />E <br />Printed/Typed <br />YP� Name <br />Transporter 2 Company Name <br />8. US EPA ID Number <br />She eu <br />Day -Year <br />W <br />R <br />y <br />l <br />• Designated Facility• • • Site Address <br />INDUSTRIAL SERVICE OIL CO. <br />Q <br />ogm- <br />ry� <br />TO ST. <br />A a <br />U <br />F <br />19, Discrepancy lndication Space <br />r <br />Z <br />A <br />tT r <br />1 <br />aY <br />Wit <br />11. US DOT Description (including Proper Shipping Name, Hazard Class,' and ID Number) <br />e ♦ <br />a, <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous 'no s covered is m s ce t as noted in Item 19. <br />O=- <br />14. Unit <br />0 15. Special Handling Instructions and Additional Information <br />aPIPPROPRIATE PROTECTIVE CLOTHING Y. , <br />Z `EMERGENCYCONTACT: (209)541--9145" <br />LU <br />EE E.R.8. 171 <br />Q16. 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 />U marked, and labeled, and are in all respects in proper condition for tronsport liy highway according to applicable international and national government regulations. " <br />If I am a large quantile generator, t certify that 11bave c program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be econoi <br />a+ prase able c +d !hat I rave set . , t. - . <mc?;^abls meth �„of trs r -at, 'r. -s, ^r d•• sa.ol curr::A, „ as s »J ;cL r. _ iha Prase: t .nj 'u!- �s . tc { nncr <br />and"the environment; OR, if I am a small quantity generator, I fiave made a goad faithreffort to minimize my waste generation and select the best wasto nanagement method <br />® available to me and that I can affnrd.P- <br />�} Printed/Typed Nome , Signature ( 1 Month D6p <br />W T 17. Trans rtef 1 Acknowled ement of Receipt of Materials <br />C7 R <br />W <br />N <br />Printed/Typed Name <br />-s <br />Signature <br />Month <br />W <br />S. <br />P <br />101 <br />2 .. <br />O0 <br />18. Trans rter 2 Ac nowled ement of Receipt of Materials <br />R <br />E <br />Printed/Typed <br />YP� Name <br />Signature <br />. <br />Month <br />Day -Year <br />W <br />R <br />q y <br />l <br />Q <br />r <br />U <br />F <br />19, Discrepancy lndication Space <br />r <br />Z <br />A <br />1 <br />f <br />L <br />a, <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous 'no s covered is m s ce t as noted in Item 19. <br />jPrinted/Typed Name [Signatul <br />Month <br />Y ^ x 1 � r� a e*%, I <br />D. NOT WRITE <br />DTSC 8022A (A/97) <br />EPA 8700-22 <br />Day Yai <br />IS LINE. <br />Green: TRANSPORTER RETAINS <br />