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Agency <br />F.mt Appa �,Mb No..ZQSG-0039 Ir p-, 9-30-991 See Instructions Ott back �e b. �`� Cj'e tment M Toxic Substances Con=rot <br />de -fr <br />Pig ase pr . •� �i arm *ec, .or csr, on 4o. f 12-pochl _'t _ Sacramento, Co14—:o <br />UNIFORM HAZARDOUS <br />1 C'e1Eraror s US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded o" as <br />WASTE MANIFEST <br />¢ t (t �i� }r j T� T <br />f_ J!It L� It <br />oF+ <br />is not required by Federal law. <br />3- Generator's Name and Moiling Address <br />3ATEPLOO ARCO - PAUL S T DHU � <br />r <br />c?� 2 E. WATERLOO RD. , 952 � STOCKTON, CA - <br />v.1�.tl,.t <br />C) <br />"'9.-56 <br />h <br />A. Generator's Phone 0 16 <br />� ' J466 <br />" <br />f\ <br />cV <br />5. Tran ter I'Company Nome 6. US EPA ID Number <br />OP <br />� <br />f. AL. 0, L C AD 9 82 4 17 2 55 <br />0 <br />0 <br />7. om n Transporter 2 CNome P Company 8. US EPA ID Number <br />J <br />Q <br />V <br />Q <br />9. Desi gated Facility Nome and Site Address 10. US EPA ID Number _ <br />NDU-TRIAL SERVICE OIL CO. <br />Z <br />� <br />1700 S. SOTO ST.ad <br />OS ANGELES, CA. 90023 -. A .' 9? 15T F 10T <br />J <br />U11. <br />US DOT Description (including Proper Shipping Nome, Hazard Class, and ID Number) 12. Conroinara 13. Toro( : 14. Unit <br />No. Type Quantify WF/Yof <br />Z- <br />0a- f✓.CRA HAZARDOUS WASTE LIQUID <br />(WATER & SLUDGE) <br />?� 01 <br />T <br />(3 <br />3 <br />G <br />i <br />coC <br />E <br />v <br />R <br />v <br />A <br />o <br />T <br />co <br />0 <br />R <br />ce <br />LU <br />Z <br />d. , r <br />LU <br />Nf <br />Z <br />0 <br />a - <br />H <br />W <br />J <br />Q <br />7_ <br />0)4. <br />Special Handling Instructions and Additional Information <br />a <br />APPROPRIATE PROTECTIVE CLOTHING <br />Z <br />'EMERGENCY Y CONTACT R t 209 a 541-9145" <br />i13EE <br />E. R. 13. 271 <br />Q <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 />labeled, in in for <br />U <br />marked, and and are all respects proper condition transport by highway according to applicable international and national government regulations. <br />t <br />J <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 />practicable and that I have selected the procticable method of treatment, storage, or disposal future <br />currently available to me which minimizes the present and threat to human health <br />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 />Printed/)Typed Name <br />Signature' <br />Month Day Year <br />0 <br />17. Transporter 1 Ac6owIe'cT9e.aprjt of Receiet ofsMa_terials <br />N <br />Printed/Typed Name Signature //r Mont. Day <br />LU <br />O <br />0 <br />18. Transporter 2 Acknowled ment of Recei t of Materials <br />0ULj <br />R <br />It <br />Printed/Typed ed Name <br />YP <br />Srgnotvre <br />_T <br />Month Day Year <br />n <br />Q <br />E <br />R <br />U <br />19. Discrepancy Indication Space <br />Z <br />— <br />F <br />A <br />C <br />1 <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered is ma est ce t os noted m Item 19. <br />T Printed/Typed Nome y Signatur Month Day Year <br />A�j <br />DO NOT WRITE ELOW T IS LINE. <br />DISC 022A (4/97) <br />EPA 87700-22 Green: TRANSPORTER RETAINS tr <br />