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M 'w— <br />" <br />Stage of CoM ornic—Envirtmcnentall Production Agmtry <br />Fur. Approved OMB No. 2050-=9 tPxgpioes "0-141 <br />Flecoit print or type. rvm oknigned for we an eyfe (17ft "wr0er. <br />1. Gene <br />ad <br />U. <br />LIJ <br />Ile <br />IVA <br />nm <br />See Inslyuctions on bac age 6. <br />Mp.H-ent of Toxic S—Irucmces Cant <br />California <br />00 NOT WRITE BELOW THIS UNE. <br />OTSC 8022A 19M <br />FIRA 9700-22 <br />13 <br />UNIFORM HAZ"DOUS <br />Generator's M FPA tD No. Manifest Document Me. <br />2. age I <br />I.i.—fion in the -vos <br />� <br />is not rwp,i—d by Federal lcww. <br />WASTE MANIFEST <br />j <br />of <br />'L -j— <br />3. Generator's Name and Mating Address <br />A. D"ent Number <br />;j-.T'ZXiAR. T 14C. <br />'i"Ir wa,:;fT 4111',rd4an8. <br />State Generator's 11) <br />A. Phone I <br />I J <br />5, Transporter I Companj Mom 6. US EPA 10 Number <br />C. S"e-Tr. 0 U- <br />arlicii <br />-Ni3mo' <br />D. transporter's Phone <br />S. US EPA ID <br />E. Shan Transporkir's in <br />F. Tragnsporlers Phone <br />9. Desitincited Facility Name and Sit, Address 10. US FPA ID N..b.- <br />G. State Faelffty's 10 <br />Q A, L <br />.4114A 9A31.)I!T-3R,3Z7 ?1ANC-3 <br />1 41 S.11 J. 1- A 11:1 <br />M US 00r Dettripfia, (including Proper Shipping N... tie-ord (1-xs. and FD Number) <br />TZ dftfo.ners <br />c <br />No. <br />Tyjm� <br />13. total <br />Quantity <br />14. 1).4— <br />VA/vol <br />1. W-10 Number <br />.ZESTDIJE <br />State <br />51-1. <br />GEPA/Other <br />4AZARDOUS WAST7-- 301,11- <br />E <br />b. <br />Stele <br />N <br />EPAJOlhor <br />R <br />A <br />T <br />0 <br />EPA/Other <br />R <br />I <br />d. <br />Stage <br />EPA/Ofher <br />I Additional Descriphocts for Materials Usled Abave Cr <br />K. Handling Codes far Waslas listed Above <br />EMPTY 12,000 gallon steel tank laipt containing",",. <br />0. b. <br />01 <br />gasoli. <br />ne. Tank inerted with dry Ice for safe <br />C. <br />cl. <br />t <br />PPROnpdr. <br />ROFILE SA4687 <br />15. Special Handling instructions end Additional Information <br />JOB #15484 J02 AlTE: BEACON STATION, J5112 <br />.24 Hr. Eme-rapncy <br />Ncr':� Cherokee <br />16. GENERATOR'S CIERTIFICATION! I hereby declare thrri The contents at this consignment tire fully and accvrc" described 1crvc by proper iNpp;.q name and are classified, <br />paniced, marked, and labeled, and am in all respects in proper tondition for trannpori by highway according to <br />applicable international and national government eq,,lotios. <br />It I am a fmge quantify generator, I terrify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have detor"nAd to be <br />scononi.ully practicable and that I tva" selected the jarucfcchle roathad of treatment, storage, or dkposril cur—lily crvoifcgbfe to me which minimises the present and lviure <br />Num* to human health and the en-irm—M, OR, if I ant a small quantity gonorinfor, I have mnde n grind frillh effort In minimize my waste generation and telect the best <br />waste managomand rm:"!h?j is avallabla: to me and that I cart afford. <br />Prindoxi/T p.d Nene <br />Y, <br />N-v\'j <br />Month Day Velar <br />Siln�'&L <br />17. Transporter I clunvAecig of it. <br />Rioted/Typed No.. <br />Signatum <br />Month Day Year <br />IV <br />S <br />ROBERT M. qR1--dSTV-R <br />P <br />74 <br />0 <br />IS. Transporter 2 Admow6j nt of Receini of AAcftrials <br />It <br />T <br />Prinfed/Typed Name <br />SgnatumMOrrTh <br />Day 'sear <br />19. Discrepancy 6d;cofiom Space <br />F <br />A <br />C <br />I <br />t <br />1 <br />2-0. Facility Owner or Opewolor Certification of receipt of hazorclocri materials covered by this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Montit D;; Year <br />f7 <br />00 NOT WRITE BELOW THIS UNE. <br />OTSC 8022A 19M <br />FIRA 9700-22 <br />13 <br />