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C'ea11omnnl of Neaan Services <br /> ;lata Ct C�hrorn,a--Health and Welfare Agency To-.Nbftancas Cansrol U.rie.on <br /> "Form Approved OM9 Na.2050--Otl30(Expires 9-30-9 1) <br /> Sacramenlo•Celdornm <br /> Please print or type. (Form designed for use on eefe(12"Pitch fypewnled. Hand sf 2. page 1 I Infolmahon m tt+e shadatl areas <br /> j <br /> UNIFORM HAZARDOUS t•GenareloC9 U}EPA IP No. pecume No. <br /> {{ nl 1 I is not required by Federal law. <br /> WASTE MANIFEST GA DI $ 0 0 6 3 7f1 3 9 A•Slat"Mand stf Q173903 aG-e�nI Numbre�rl <br /> 3.Generator's Ntmo and Marling Adarese l("I / 3 9 113 <br /> I Coca Cola Bottling Co. p.State Generator's iD 1 V <br /> 1100 North Wilson Way Stockton, Ca. 95207 I 1 <br /> a.Gene 602 829-6315 David Didier A ent 213217 <br /> 5. Transporter I ComPany N°hie li. US EPA 10 if ii C.state Transportur'a I6 <br /> - Rich Sand Ethridge Co. C AD 0 2910 7211' 7 <br /> O, Trenaportef',Phone 408-627-2395 <br /> 7.Transporter 2 Company Name a. US EPA IP Number I E.state T,ansporter's 10 <br /> v F.Tran°porter's PhaPa <br /> I <br /> 9. Designated Fecrhly Name and Site Address 10. US EPA ID Number G.Stale Facility's!D <br /> Gibson Pilot /JV C IAI D.0 14l 312 I61 0 0 2 <br /> 4H.Facility's Phone <br /> 475 Seaport 415-368--5511 <br /> Redwood Cityp Ca. 94064 (11 Ar)10.4�3L2_6 mo 2 1• <br /> 12.Containers 13•Tolot 14, <br /> Waste Na. <br /> ,t auantify I Unit <br /> 11. US DOT Description(Including Proper shipping Name.Hazard Claes,and l0 Number) I No. Type lWt/Vol <br /> State <br /> NOS ONE <br /> Hazardous Waste Liquid I EPA,aher <br /> E ORM-E NA 9189 D018 0 T I U State <br /> —'° E b. f <br /> p EPA10ther <br /> A <br /> IV T I i slals <br /> 0 <br /> R <br /> C. <br /> EPAIOlhor I _ <br /> A I{ I Stale <br /> 7 d. f{ <br /> EPA1Other <br /> i III <br /> 1 <br /> _ K.Nantlling Cotlas tot Wastes Listed Above <br /> J.Additional Descripliona lar Materiala Liated Above a• b. <br /> Ol <br /> µ <br /> 99$ Ground water d• <br /> f <br /> Less than 1% Petroleum Hydrocarbons <br /> ation <br /> z tRicGhf 5andaEthridgeidConet t•rm(408) 627-2395 (24 Hours) <br /> National Response Center with in Ca, 1-800-852-7550 anG.cOaRl 10485 localC.H�P. <br /> Use qo les laves res irator. <br /> ,e. described <br /> _J GENERATOR'S CERTIFICATION:marked,end tegeledjaeto nd a,e nail aspects n proper condition%[acontents at ibis consignment tufty <br /> ttanspan by naianw0Y accoldingbtov.00cabl°international onal and <br /> a and are classified.packed. <br /> national government regulation°. <br /> ' It t em a large quanlifY Qaneretar,I Ceriily,that I have a program in place to reduce the volume and foklcny of wade generated la the degree I have detarmmed <br /> ? to be econamical:y practicable and that I have selected the practicable method of tre°lmenl.storage,or disposal currently evadable to me which minimizes trio <br /> present end future throat to human heatlh and the <br /> anvednment;OR.it I em a smell quenldY generator,I have made a Odoa faith apart to mlmmpoo my waste <br /> generation and select aria best west"management method that Is avoidable to me and that i can afford <br /> - <br /> 00arh Coy year <br /> i <br /> Pr i etl1 Typed Name ! 1 <br /> _ I � <br /> T 17. M11149dr,er I Acknowledgement of Aece+pl 01 Metefula ;Ipnth ,-17 �Y••tf <br /> A sign two <br /> --1 A Prsn,etlr Typed Name " J I t •r L!• <br /> 1 d- Transconer 2 Acknowledgement of Receipt of Materials <br /> 1i j <br /> S gnnture <br /> K =)Printed,TyPed Name I , <br /> 15 Discrepancy Indication SpaCa <br /> zl <br /> I <br /> O+.ne/or Operator Certification et le etpi of harPreoua malendil Ca+�rad by In's ntnAdall P.U•pr d]no1Po1+n Ir+m 1+ ;tar <br /> !.IJafl .r <br /> . - Si(Inalule - <br /> _.— ,_T-- - p,!ntna:_Tvped.Name <br /> _—_ <br /> e022 A(1:Of,) Do Not Write Below This Lincrw- <br /> �t <br /> r 'o nn)Prav+ous ea.lmns are obsolete. moll 111111 <br /> l <br />