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Stara of CcIiomia—Enviramrmd Protection Agency <br /> Form Approved OMB No.2030-00.19(Eapira+83094) ten-' SRs Inshudiom on,back Of pot,.J. 0•P°rtn'e^t of Toak Sabaancec Control <br /> Plume prim or type. Form dna gnell rx:ae an aRls(12pitzi ypnwiler. c Socrame:so,Cakforria <br /> 1. s US EPA ID No. •Manihd Doumnrd Na 2. Page 17 Information in the shaded areas <br /> UNIFORM HAZARDOUS / is not required by Federal law. <br /> WASTE MANIFEST 17 1 n l , a , <br /> 3. Generrdor's Name and Mailing Address <br /> NATIONAL_.'QUARD OMS #24 <br /> 8010 S. -AIRPORT WAY STOCKTON CA 95205 <br /> 4. Generator's Phare (!) ) 192-141115 <br /> S. Transporter 1 Company Name <br /> 6. US EPA ID Number <br /> m <br /> ENVIRONMENTAL RECOVERY SERV. <br /> -s 7. Tran•perter 2 Company Name <br /> B. US EPA ID Number <br /> U <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> BKK LANDFILL <br /> 0 221_0 S. AZUSA AVE. <br /> J 01701 <br /> a <br /> V 12. Comainen 13. Tonal 14. Unit <br /> Z 11. I15 DOT Dmcdplion(mdudmlp Proper Shipping Nome,Hazard Class,and ID Number) No. Type O:ra::My W1/Vol <br /> x a. <br /> WASTE BRAKE SHOES <br /> of NON RCRA HAZARDOUS WASTE SOLID D 'm O P <br /> m N Is. <br /> E <br /> R <br /> A <br /> T u <br /> oP O <br /> Rrill I I I I I <br /> y <br /> Z d. �1 <br /> U <br /> 41) 1 <br /> O <br /> 6 <br /> H <br /> W <br /> K <br /> J <br /> a <br /> Q13. Special NodGtg Instruction,and AddBbrrd Nlot malim <br /> i USE PROPER SAFETY EQUIPMENT BILL TO: ENVIRONMENTAL RECOVERY SERVICES <br /> W EMERGENCY CONTACT - CHEMTREC 1-300-424-9300 EMERGENCY GUIDE @ 31 <br /> x <br /> t- <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment aro fully and accurately described above by proper shipping name and aro classified, <br /> J ked,marked,and labeled,and arc in all res :n proper condition:for transport highway according to applicable federal,acres and inrornational lows. <br /> a Pec pacts P Per Po by 9 ay M <br /> U <br /> ,,2 If I am a large quantity generator, I certify that I haw a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> J economically practicable and that I haw selected the practicable method of healmer:h storage,or disposal currently owilable to me which minimizes the present and fuhro <br /> ythreat to human health and the enviromnent; OR, 8 1 am a small quantity generator, I haw made a good faith effort to minimize my waste generation and select the been <br /> wane management method that is arailable to me and that I can afford. <br /> O Primed/Typed Name re Month Day Year <br /> ZT 17. Transporter 1 Acknewled of :pt of Materials <br /> N rim <br /> Ped/Typed Name Si ro Marsh Day Year <br /> WW s <br /> m <br /> F o 1 r 2 Acknowle vt of Rem6pt of Materials <br /> LLe Printed/Typed Name Signature Month Day Year <br /> 0 <br /> rW 19. Discrepancy Indication Space <br /> a F LS <br /> U A <br /> ? L JAN 2 5 1995 <br /> I 1 20. Focilitv Owner or 0mrsmor Certrfkaion of receipt of hazardous materials covered by this mar:ifest exc m noted in Item 19. <br /> T Primed/Typed Nome Sigxsere Day <br /> Year <br /> r.NVIRONME A ATH <br /> PERMIT/S VI ES <br /> DO NOT WRITE BELOW THIS UNE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DISC 8W2A (7/92) To: P.O. Boa 400, Sacrnrmmo, CA 958124400 <br /> EPA 8700-22 <br />