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State of Cal ifornia—Enviterritorial Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9.30-991 Sec Instructions an back of pagB':i. Department oFTax lc Substances Control <br />Please print or type. Form designed for use on elite f 12 -pi;; f type w 'ter. _ r Sacramento, California <br />1. Generator's US EPA ID No. Manifest Document No. 2, Page 1 Information in the shaded areas <br />UNIFORM HAZARDOUS is not required by Federal low, <br />WASTE MANIFEST A O 5 7 v 4 of 1 <br />3. Generator's Nome and Mailing Address A. Stot Manlfest Document Number . <br />3807 CORONADO AVE 24639164 <br />0 STOCKTON. CA 95204 B. State Generators ID .... . - 60 WO _ <br />4 Generator's Phone 1 2 09 9 3 7- 5 8 0 1 <br />n <br />C14 5, Transporter 1 Company Ncme d. US EFA @Number C. State Transporter's Ip [Reserved.[ <br />s[S <br />o .SAFETY-KLEEN SYSTEMS; INC T O 0050 30 D. Transporte�sPhone <br />C>- — <br />1011 <br />7- Transporter 2 Company Name 9, US EPA ID Number E -. State Transporter's ID [Reserved.j <br />�J <br />coQ <br />�V <br />CT)d <br />Mat <br />(DO= <br />�Q <br />N" <br />Z <br />s <br />a <br />su <br />r <br />Z <br />to <br />V <br />W <br />N <br />Z <br />0 <br />a_ <br />sr) <br />W <br />Q <br />Z <br />0 <br />Z <br />Lu <br />r <br />H <br />d <br />U <br />a <br />0 <br />} <br />V <br />Z <br />su <br />Ulu <br />ac <br />0 <br />W <br />N <br />• U <br />Z <br />` DO NOT WRITE BELOW T LI <br />PR p.L A)0002289766 <br />S MP L A } 0040128365 Whirl: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DISC 8022A 1 /991 To: P.O. Box 3000, Sacramento, CA 95812 <br />EPA 8700-22 <br />11 111 11111L <br />- F.' Transporner's Phone <br />9. Designated Facility Nome and Site Address 10. US EPA ID Number <br />G; Stote Facili 's ID _ - <br />A O 0 33 2 <br />050122 <br />DEMENNO / KERDOON <br />H: Facility's Phone <br />2000 NORTH ALEMEDA STREET CAT080013352 <br />310 537-7100: <br />COMPTON CA 90222 <br />12.Coriners <br />13. Total <br />14. Unit <br />11 US DOT Description {including Proper Shipping Name, Hazard Class, and ID Numberl <br />No. <br />Tye <br />Quantity <br />WI/Vol <br />I. Waite Number <br />Stole <br />a. RQ WASTE GASOLINE MIXTURE 3 UN1203 PG <br />11 <br />134- <br />(. DO01) ( ERG# 128) <br />DF <br />C) <br />, EPA/Other DO01 <br />G <br />E <br />b <br />State <br />E <br />EPA/Other . <br />R <br />LL <br />A <br />- <br />Stole ' <br />T <br />` <br />0 <br />EPA/Other. _ <br />R <br />State <br />d. <br />EPA/Other <br />J. Additional Descriptions for Matarka4& Listed Above - - <br />K. Handling Codes For Waste: <br />Listed Above - <br />a. Qi b <br />IA) D018 <br />d. <br />15. Special Handling Instructions and Addilianal Information MF S T <br />R/ T# 106 918 4 5 7 0003-0296-27 <br />EMERGENCY RESP 800-468-1760(24 HR). IF UNDELIVERABLE <br />RETURN TO GENERATOR. <br />SK CORP AUTHORIZED TO RETAIN LICENSED SUBSEQUENT <br />CARRIERS AS NECESSARY. <br />SKDOTA91 <br />B' C' <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the conlents of ti consignment are fully and accurately described above'oy Proper shipping name and are classified, aackad, <br />for !rampart by highway according to applicable internalional and notionol government regulations. <br />marked, and labeled, and cre in all respects in proper condition <br />If 1 am a large quantity generator, I certify that 1 have a prog9ram in place to reduce the volume and tonicity of waste generated to the degree I have determined to be econci 11y <br />disposal currently available to me which minimizes the present and future threat to human health <br />of treatment, storage, or <br />praclicoble and that #hove selected the pracficabte meth all <br />the OR, if I am a small generator, I have made a good faith effort to minimize ante generation and select the best waste management method that is <br />and environment; quantity <br />available to me and that I can afford. <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />} <br />0 <br />1 6 <br />T <br />17. Trans rte, 1 Acknowled ement of Receipt of Materials <br />I <br />Print ad Name <br />Signatu a <br />Month Day Year <br />016 <br />S <br />o <br />P <br />q <br />18. Trans orter 2 Ackncwled ement of Recei. t of Materials <br />Month Day Year <br />R <br />T <br />Prinled/Typed Name Sig t <br />I I <br />E <br />R <br />19. Discreponry Indication Space <br />F <br />A <br />C <br />I <br />iii ner ar O orator Cerlificano of receipt o <br />hazardous materials covered b Ibis manifest exce t a noted .n Its <br />T <br />ri /Typed ome <br />Signature <br />Month Day Year <br />y <br />�`?— <br />` DO NOT WRITE BELOW T LI <br />PR p.L A)0002289766 <br />S MP L A } 0040128365 Whirl: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DISC 8022A 1 /991 To: P.O. Box 3000, Sacramento, CA 95812 <br />EPA 8700-22 <br />