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'ease prix l or h pe. Farm designed for use on elite I2ndch)typewriter, Socrar elm.Cmitontia <br /> mro <br /> UNIFORM HAZARDOUS etoi,US EPA ID No. Mmwm <br /> anlle,t Docuen2. Page 1 Informatn in ,shaded areas <br /> is not required err Federal law. <br /> ' WASTE MANIFEST `� <br /> C !0101019 010 5 .1 2 811 t 4 °' <br /> Garostnr's Name and Moiling Address A. State Manifest Document Number <br /> u, <br /> I -Robert Foppiano 92881 <br /> 1 8427 Balboa Avenue, Stockton, CA 95209 s. Stab Gimmaon,1D <br /> hl <br /> e. Generators Phone i I <br /> rS. Transoorrer I Company Nome 6. US EPA ID Number C. State Transpade:s ID E/� <br /> NOR CAL OIL 1C A D 19 8 2 14 1 7 2 5 5 ° T.ampate:'Ph. ((209) 667-6692 <br /> 7. Trampo.ter 2 Company Name 8. US EPA ID Number E. Stab Transporter's ID <br /> V <br /> F. TromgoMr's Pham , <br /> Z 9. Dengnmed PodGN Nome and Site Address 10. US EPA 10 Number G. State Facility's ID <br /> XREFINERIES SERVICE CAD 0 '813 1 6 6 7 2 8 <br /> 1` 0' 13331 N. Hwy 33 H. Facility's Ph. <br /> CD <br /> al Patterson CA 95363 ICAD 10 18 13 11 16 16 17 2 18 (Affl) 874-4444 <br /> 00 12. Contai <br /> 11. US DOT Description)including Proper Shipping Name,Hazard Class,and 10 Number) <br /> Z No13, Total 14. Unit <br /> . r ner Ouamiy Wr/vol I. waste Number <br /> � � <br /> °NON-RCRA HAZARDOUS WASTE LIQUID smote <br /> 3 c (WATER & OIL) 0 011 TIT �T 16 G EPA/Odler <br /> E <br /> 9 N Is. I Stam <br /> E <br /> h R EPA/gher <br /> e A <br /> T State <br /> O <br /> R EPA/Other <br /> WI <br /> ZI d. slab <br /> Wi <br /> U <br /> I EPAjOlker I <br /> w <br /> N <br /> J. AddMoral Descriptions for Materials Above '. R. HondBrtgWastes.Cedes for Wms limed.Above <br /> O ' <br /> � TANK BOTTOM WASTE Q Q.w <br /> o l RINSATE <br /> 0; 15. Special Handling Instruction,and Additional Information <br /> APPROPRIATE PROTECTIVE CLOTHING <br /> Z' "EMERGENCY CONTACT: (209) 667-6692" <br /> ii SEE E.R.G. PAGE 31 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicac a federal,slate and international low,. <br /> U <br /> If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of wane generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently o•ail.ble to me which minimizes the present and future <br /> sthreat to human health and the environment,OR, if I am is small quantity generator, I have mode a good faith effor to minimize my waste generation and select the best <br /> 2 waste mono ement method that is available to me and that I can afford. <br /> O Printed/Typed Nome Sgo turs, Mon`h� Day Year <br /> �' for ROBERT FOPPIANO 7I 1ri9 <br /> Z t 17. Tronsaerer I Acknowledgement of Receipt of Materials <br /> a' Printed/Tvoed Name yn Signatum Mamh Day Year <br /> y i �(� I f.<—� <br /> f 1 0 18. Trans ter 2 Acknowledgement of Receipt of Materials <br /> moi j Printed/typed Name Si Nre Month Day Year <br /> �' <br /> As 19. Discrepancy Indication Space <br /> ,n <br /> Q F <br /> U A <br /> Z C <br /> I <br /> I. <br /> 1 20. Facility Owner or O .rotor Certification of receipt of hazardous materials covered by this manifest except as noted in hem 19. <br /> T Primed/typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> shite: rSC- :ENDS THIS COP'{ TO DTSC WIPaIN 30 DAYS. <br /> DISC 8022A (7/921 To: P., Eos 3000, Sacramento, CA 95812 <br /> EPA 8700-22 <br />