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~Blah 40%ohlornle--He nth ana Welfare Agency 04800""':"tof Msalm So <br /> prmeae <br /> Form Apoved OMB No 206t� g3 <br /> O9[Expires Y 30.91) Toxic Substaness Control Division <br /> aieaaa Print or type (Form designed for use an elite i 12 birch rvoewnrero sacromanlo Can <br /> UNIFORM HAZARDOUS lonerstor s US EPA ID No remnant 2 Document No Pe9e 1 i :nformstlon in Ina enticed areas I <br /> WASTE MANIFEST n '/ I ! of s not regulred by Federal law <br /> 3 111.11*1l .and Malang Address r A. State-I4mWeef Document Number ' <br /> M <br /> Kennon Dist. 7`490100-1 <br /> 4110 Industrial way B State Generators 10 z•,� <br /> 916 372 4600 1 <br /> 6`Transporter 1 Conically Name d US EPA ID Number G ate Tranaponera I ' <br /> ~' OIL CONSERVATION SERV*CM ICAD 981 ,4281 r)22 I D TransporlerePhone <br /> ^ <br /> 7 Transponer 2 Company Name a US EPA ID Number E State Transporters l6 � <br /> 9 I F Trafteponers Phone <br /> 0 08er9nille0 Fatality Name end Site Address 10 US EPA 10 Number G State Factift a ID F <br /> Gibson Ott Co =11n4ah M9111 1177 ! <br /> s nND or COMMERICAL DR. H papNty.pr,d1e <br /> BAKERSFIELD CA 83301 905 327 0413 <br /> N ¢I q 80 1;3831 177 <br /> O I 12 Containers I 13 Tolal 14 I a <br /> 11 US DOT De p ppity Name hazard Claw and ID Numoer) I I Quor"tv, Unil Waste flea .,. <br /> 4 ti abrtpiroa(kictudktp Proper Shr NO 7vpe I W11V01 <br /> © z a CALIF REGULATED WASTE ONLY slate <br /> Non RCRA Ham. Want* - -quid � EPArofhr b1 <br /> nomm <br /> E b I I State <br /> a, R <br /> A <br /> ao T 1 I EPAOCOW t�pfa <br /> Y O 1 <br /> CM R c Stale yF ; <br /> S � � ' 1 <br /> � k EPAIOIhe►�.+ <br /> r <br /> W d e <br /> Z <br /> W EPAI <br /> U _ <br /> W <br /> O �1- nM�er• ;er A..botrwlg4�Z - : a l .f.yFn. '�� i IaIF. HraedlYld.f pdN fMWaatearlreed� } <br /> y - e1r .'1 ;riw <br /> Y <br /> j�4 =`5 1�r .[ 'Y�.,.' r r�l✓`I 'ry L Y++•r P <br /> �1 <br /> 1 15 Special Ifalldlhtg kestroetlaw and Addition- Ntarmatlorl <br /> _ t - <br /> refer to Invoice <br /> J <br /> to <br /> t <br /> GENERATOR'S 71CATION 1 hereov detYare 111.1 the contents of this conslgnmant are fully and accurately described above by proper ahippintl name <br /> and are classified packea marked end labeled.she are m AN r..peeproper condition In propcondition for transport by highway according to applicable lntemn <br /> attoai and.r <br /> w nelional govrhmaet repeiatione �F <br /> If I am a large Qllarttlty generator i candy that 1 have r program In place to reduce the voiume and toxicity of waste generated to the degree 1 have delermYted <br /> to be economically practicable end that I have tiMecred the practicable method of treatment storage or alspoaai currently available 10 me which m,nMmzea 1110; <br /> Y 1lrnent and futw Pirelli to human health end the emndnmern OR if i em a amati quantity generator I have made a 9000 faith effort 14 rrtmrmrse my wool@ <br /> U 9enerstbn No•Heel the peel waste mane9etrre <br /> ed ef110d that Is aradabte 10 mend that i can attrd - <br /> PrlmtowTyped Name, Slgmsturs Month Der Y/saw <br /> WTR 17 Trsnaponr t AcsmOeled9sment of Receipt of Materials <br /> Z <br /> A PrlMad/Typed Nam � Signature +Month any Yeaar. <br /> N r <br /> LL <br /> 0 p 7 <br /> f N rlr O 10 TranapO2 AcknOvMdgem@M of Reaarpt of Materials <br />' t t T Pflnf@d/Typ@d H@mt@ Signature <br /> month Day Year <br /> f Z E <br /> st 19 Diecrsllancy ir4Watl0a Space <br /> 1 F <br /> A <br /> 1 C <br /> I <br /> L <br /> 1 20 Fecdrty l7wrMr or Operator Certification or recerpr of hazardous materials covered by this manifest except as noted in Item 19 <br /> T <br /> Y Printed/Typed Name Slgmetwo Afahth DaY Year <br /> DH8 SM A(1 I= Do Not Write Below This line <br /> EPA 111700-22 <br /> (Rea WWI Prances ed111ona are b*oM* <br /> GREEN HAULER RETAINS <br />