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State of QolifQmio—Emnronmentcl Protection Agency <br /> Form Approved OMB No 2050-0039(Expires 9 30.96) See Instructions an back of page 6 Department of Toxic Substances Corotrol <br /> Please print or type Form desryned for use on eine(12pnch)typewnler Smromerta California <br /> UNIFORM HAZARDOUS 1 Generator's US EPA ID No Manifest Document No 2 Page 1 Informahon m the shaded areas <br /> rs not required by,Federal law <br /> WASTE MANIFEST i� G 0 of <br /> 3 Generator's Name and Mailing Address GrARD)= PBl3PS8TT A State AAamfest Document Number o <br /> 20WO TI1ORIMN ROAD <br /> B State Generators ID <br /> `%1 THMMN, CALIF. <br /> 00 4 Generators Phone (209)5 75-2221 <br /> 9 5 Transporter 1 Company Name 6 US EPA 1D Number C State Transporter's ID <br /> C9 D Transporters Phone <br /> r <br /> J 7 Transporter 2 Coma Name $ S PA ID Rum r` - E State Traresporfor's ID <br /> Q � P nY <br /> U <br /> d I I I I I I j I I I I IF Trainslhorters Phase <br /> 2 9 Designated Facility Name and Site Address 10 US EPA ID Number G State Facility's ID <br /> p D0 f SON <br /> 2000 NORTH AtAMEDa1 ST. H Foaldy's Phone <br /> COMPTON CA 90222 <br /> Z 11 US DOT Description(including Proper Shopping Name,Hazard Class and ID Number) 12 Containers 13 Total 14 Unit <br /> No T Qua Wt/Vol I Waste Number <br /> State <br /> 3 NOR RMA HAZARDOUS VAM. LIQUID (OILY WATER) EPA/ <br /> G { <br /> DIMb <br /> cc N 4 E State® t. <br /> C-4 R EPA/Other <br /> ado T c State <br /> O EPA/Other <br /> LU <br /> R <br /> Z d State <br /> W <br /> V EPA/Other <br /> W <br /> J Additional Descriptions for Materials Usted Above K Handling Codes for Wastes Lasted Above., h <br /> a b <br /> W <br /> cm N.A.E.RX. #128 t d <br /> Z <br /> z <br /> 15 Special Handling Instructions and Additional Information 1 sasENCY RUMNSE CX ICT 24 EONS <br /> Z GIAY$S 8 O+,:GGL.LrS KIM i A"ER (510) 886-3400 X320 <br /> IJU (310) 802 9895 <br /> t- <br /> 16 GENERATOR'S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shopping name and are classified <br /> V packed,marked,and labeled and are in all respects in proper condition for transport by highway according to applicable internal onal 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 <br /> a- economically practicable and that I have selected the practicable method of treatment storage,or disposal currency available to me which minimizes the present and future <br /> to threat to human health and the environment,OR if l am a small quantity generator I have made a good forth effort to minimize my waste generation and select the best <br /> tr waste management method that is available to me and that I can afford <br /> O Signature rnth Day Year <br /> r Printed/Typed Name 9 r ter,, r <br /> (J xyn� - t 4 i f .,i e ]r �r' ♦.�1r sr t ' Y 1 x ,� r r- <br /> 1Z Th 17 Transporter 1 Acknowledgement of Receipt of Matenols r <br /> (D A Pnnte#OT "d Name i Signature Morith Day Year <br /> LU 5 ,'✓ �� `� f ._.1+-- '^� �r�i <br /> P 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Monts Day Year <br /> 0 E <br /> N 19 Discrepancy Indication Space ` <br /> Q F <br /> U A <br /> Z C <br /> I <br /> L <br /> I <br /> 20 Foal Owner or erafor Cerhfxahon of receo of hazardous materials covered b this marnfest ext t as noted on Nam 19 <br /> 7 Pnmed/Typed Name Sognafisre Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE <br /> DTSC 8D22A (9/94) <br /> Yellow GENERATOR N <br /> EPA 6700-22 <br />