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,I. Crpmen p, p 1 O/T:E <br /> LI -alar's US EPA ID No. Manifest Document Nom.- 2. Page I Information in the shaded areas <br /> UNIFORM HAZARDOUS li is not required by Federal foes. <br /> 'WASTE.MANIFEST . .: 9 16 3 2 2 4 1. of 1 <br /> 3. Generators Name and Mailing Address <br /> AD ART i <br /> P. O. BOX 5570. STOCKTON, CA 95202 � <br /> A. Generator's Phone 1209 1931-•7772 <br /> 6, Transporter 1 Company Nome 6. US EPA ID Number II <br /> NOR CAL OIL C AD 9 B2 4 17 2 55 <br /> 4 7, Transporter Company Noma. EPA ID Number <br /> 9. Designated Facility Name and Site Address I0. PA 10 Number !� <br /> INDUSTRIAL SE PV I CE'. OIL C0; l s. <br /> 1 17014 S. SOTO ST. <br /> L05 ANGELES. <br /> CA. 301[ 2'3 : C D i� 5 4 `�2 1 lis" <br /> 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) _ 12 3 Containers„ 73. To`hdly, td, Unit <br /> i "" Nd: Types . Quantity Wt/vol _ <br /> N014--RCRA HAZARDOUS WASTE LIQUID,,— <br /> AG!C $t_UDC�E1 01 011 T T ✓ �� <br /> r n,n 4 G . <br /> E I: + .. <br /> b; sLy <br /> I A r <br /> T <br /> C. <br /> t <br /> F <br /> 0" <br /> a _ <br /> d. <br /> ij <br /> if <br /> ! 15. Special Handling Instructions and Additional Information <br /> APPROPRIATE PROT ECT I UiE CL©THIN© _S I TE 'ADDRESS <br /> 1 "EMEPGENCY CONTACT:., 91 5 y 3133 AD ART RD- <br /> SEE <br /> LQ_ <br /> SEE E.P,. G. 171STOCKTOh1. CA <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are My and occuralelyy described above by proper shipping name and ore classified,packed, <br /> marked,and labeled,and are in oil respects in proper condition For transport by highway according to applicdble Wernotionol and netiono[goverment regulations,. <br /> If I am a large quanfity generator,I certify that I hove a program in place to reduce the volume and toxicity of wpste generoled to the degree I have determined to be economicolly <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> -- -.ap?:-r,`ti e_-_? ,e f:-_=ede:L_ L-:+etfvrt.tc s-.I—t th»bed wnste mri",eim_nt method that is <br />} available to me and that l can afford. Tv l <br /> Printed/Typed None Signature 1sa Month Day rar <br /> r - ... <br /> •T17. Trans rter I Acknowledgement of Receipt of Materials >i <br /> E j Printed/Typed Nome Signature �J Monj Doy ear <br /> jll I ` KEN S. PUETT 0 7 ffis <br /> 0 18. Trans rter 2 Acknowled emenf of Receipt of Materials <br /> MT. Printed/Typed Nome Signature Month Day Year,- <br /> f E <br /> ! R <br /> 19, Discrepancy Indication Space <br /> 20. Facility Ownerrrrggqqqeeeor Operator Certification of recei t of hazardous materials covered b 'this ma st except as noted in Item 19. <br /> T Printed�ep�No S,gnawrit Doy - Year <br /> f NOT WRi E BELOW T IS flNE. <br /> 'SC 802?A(4/97)• 3sitli' <br /> Grocn; TRANSPORTER RETAINS!. <br /> it,.'8700-22 <br /> �14sr �" v'. <br /> r <br /> "'�•.t 't _, - n":t�y.� �7.i�.�!�ii���'��".1� ���t��ta�i i"� 1'� � .f.l .,.- 'a .. 'e *tet-_ 3 <br /> t- <br /> s <br />