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1 MateatCalifornia—•Envirohmen101 Profe49ion en <br /> •Form Approved OMB No. t54-:W39 Wcpinss 9-30-9q1 +A + P <br /> 'Please not or. J See Instructions on back of pcigr' Department of Tozic Su t <br /> p', 1ypa.- Form ifesigned for use on slits}(12 p rchJ rypewr�t - ' / 1 { <br /> •' ,.• Sacramento;Californio-e <br /> UNIFORM H DOUS;: Y' Genera sus EPA rD No. .. `, i <br /> ' Manifest!Document No: 2. Page 1 humation in the shaded <br /> ` WASTE MANIFEST Y I° i <br /> / f d 1 v� areas.. <br /> a� is not required by FaderaF few <br /> iGenerator i Nome and Mailing Addres► <br /> a oft S <br /> r Qdvrr (A 4f <br /> 4�ER iroto s f iFone J��elv h <br /> porter 1 Company Name6. US EPA ID Numberrr oICAN VALLEYWAS>'I OIL <br /> 0823 +;porter 2 Company Name8,.US EPA ID Number <br /> nated Facility Nome and Sate Address <br /> yta TIRIAL SERVICE colt,GCT, INClo. us EPA ID Number. SOTO ST <br /> �1VT Description(including Proper$hipping Name,' Class,and ID Number) 12• Coiners 13. Total 14.No. T Quanfi Wt/Vo1 <br /> NOWRCRA HAZARgOUS-WAS` ELIQUID1p _._.�._. <br /> t Q N <br /> mm E. :. ! <br /> N R <br /> A.. <br /> a <br /> U. <br /> m 05 m <br />�. t. �. � <br /> d. 'p <br /> f <br /> 0 .. <br /> LU <br /> .Q � <br /> r 0 15,-Special Handling Instructions.and Addition gyp... <br /> z . GLOVES <br /> W EMERGENCY PHONEY 2i?9�7-8857 ;. _ <br /> Q 16:GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate)y de�cribsd a6ore�yshipping <br /> u' V marked,and labeled,and are in ail rerpects in proper condition for transport by highway according to applicable interniationarand national government ernmen regulations.name and are iFi°d'packed <br /> v l <br /> If 1 am a 1or1e uanti generator•I c h <br /> �__ �y 'f.PI 1�taY48 D�pgPD90.itf'.ftFe�a -dna pnd laxfelty of YH3vs der%nTiied'td Taeconorntc0 <br /> '"�"rbcficuTiYa'and <br /> al"F JL <br /> ielectedtAe cttcablla method of treotment,'srorage,or disposal currently available to me which mi imizes the present and Folate threat ro human hepf <br /> r anal dreeaaronmenr;OR �E;1 arp a rm I quantity genermor Y haw mode a good Faith effort to minimize waste, <br /> P r avoirabie ro me alyd illat'I can afford - M- <br /> t Y :• :T •w:.� mYI ! "Otian.a .selr_t.the best.waJ_e-mcnagementmShodtba'o: " <br /> r V Pri Y Name r/�l M!r Vi. Signature J r / qb Day t+ <br /> ct. ( i ' <br /> It 17. Trans otter 1 Aeknowled ement- Ret of Materials / 1 <br /> a p f.., <br /> Lu ''A Printed me <br /> k _ s �( Signature L nth Day . - <br /> w ,Q 18. Trans Iter 2 Acknowled ement of Recel f of Materials <br /> Printed/Typed Name' + rl l t <br /> Uj <br /> :' ? S pnature <br /> R - .. rf. - - �, ..,r h'r. R.- r-• -Month -Day <br /> U � 19. Discrepancy Indicot+on Spgq <br /> a <br /> 20. Fauh ,Owner or O rotor Corti icahorr of r i I of hazer materials covered b manifest exce t as noted m)tem <br /> #, T Printed/ Na ' <br /> Y Signature <br /> �' - ` C• Day ,„x.,r- � <br /> DO NOT WRITE', BELOW THIS LINE. <br /> Yellow: T$DF SENDS THIS COPY TO GENERATOR WETHIN 30 DAYS- <br /> DTSC 8022A(4/97) (Generator's who submit hazardous waste For Irons ,1 out <br /> EPA 8700-22 / produce ' <br />