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State of Cal fornia—Environmental Protection Agency <br />Farm Approved OMB No. 2050-0039 lExpires 9-30.991 <br />Please print or type. Form designed for use on elite f f2-pi;,✓fs lypewaaer.t a <br />L <br />Ln <br />n' <br />f4 <br />Ln <br />m <br />co <br />o <br />�d <br />�Q <br />CV I <br />0 <br />Cci <br />co <br />v <br />C`1 <br />O <br />0 <br />00 <br />CX <br />LU <br />ti <br />Z <br />w <br />V <br />LU <br />V] <br />Z <br />0 <br />CL <br />in <br />W <br />tK <br />Q <br />Z <br />0 <br />Q <br />Z <br />IIA <br />oL <br />C <br />See InStrUCtlofl5 on back Of page DepartmentofToxic'Su6stancesContrvl <br />n s ``yl it J Sacramento, California <br />l DO NOT WRITE BELOW T LIN <br />PR L A )0002289766 <br />SMFL A) 0040128365 Whi e: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br />DTSC 8022A 1f991 To: P.O. Box 3000, Sacramento, CA 95812 <br />EPA 8700-22 <br />1. Generator's US EPA ID No. Monifest Document No. 2. Page 1 Information in the shaded areas <br />UNIFORM HAZARDOUS s not required by Federal law. <br />- <br />WASTE MANIFEST I A O 5 7 4 of ,i <br />3. Generotor's Name and Mailing Address A: Slol Monifasl Doc,rn.m Number <br />24639164 <br />3807 CORONADO AVE <br />STOCKTON GA 95204 B. State Generator's ID <br />4 Generator's Phone ( 209 9 37-5801 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. -State Tronaparter's 1D [Reserved.) <br />SAFETY—KLEEN SYSTEMS, INC T )0 0050 30 <br />P. Transporter's Phone <br />C -1 <br />7. Transporter 2 Company Nome S. US EPA ID Number <br />E.,State Transporters ID Reserved.} <br />i <br />F ` Trcnspatler's Phone <br />9. Designated Facility Name and Site Address 10, US EPA ID Number <br />G: State Foeili <br />050122 <br />A 0 0 33 z <br />DEMENNO / KERDOON <br />W FaaiPity';Phone . <br />2000 NORTH ALEMEDA STREET C:AT080013352 <br />COMPTON CA 90222 <br />310'537-7100;' <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Numbers <br />12. Cortlainers <br />13. Total <br />Ouantity <br />14. Unit <br />Wt/Vol <br />1. Waste Number <br />No. <br />Type <br />State. <br />a. RQ WASTE GASOLINE MIXTURE 3 UN1203 PG <br />II <br />134- <br />EPA/Other • <br />! D001 ( E R G # 12 8) <br />DF <br />G <br />Ip <br />DOOI <br />E <br />b <br />State <br />N <br />E <br />EPA/Other <br />R <br />A <br />State <br />T <br />c <br />0 <br />EPA/011ier <br />R <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions For Materials listed Above - - - <br />K. Handling Codes for Wastes <br />Listed Above <br />IA) D018 <br />a Q� <br />b. <br />�. <br />d. <br />PO 34 1P <br />15. Special Handling Instructions and Additional Information MF S T R / T # 106 918 4 5 7 0003-0296-27 <br />EMERGENCY RESP 800-468-1760(24 HR). IF UNDELIVERABLE RETURN T.0 GENERATOR. <br />SK CORP AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY. <br />SKDO 9 D. - <br />'1d. <br />16.GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described obova 6y proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport y highway according to applicable international and naiionol government regulations. <br />if I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste genercI to the degree I have determined to be economically <br />treatment, disposal currently available to me which minimizes the present and future threat to human health <br />practicable and that 1 )save selected the practicable method a slarage, or <br />and the environment; OR, if I am a small quantity generator, I have made a good 6fh effort to minimise ante generation and select the best waste management method that is <br />available to me and that I can afford. <br />Printed/Typed Name SignatureMonth Day Year <br />IF <br />l 0 <br />1 <br />17. Transporter 1 Acknowled ement of Rmi pt of Materials <br />R <br />Print ad Name <br />Signv1u a <br />Mvn�.� Day Year <br />016 <br />S <br />e <br />P <br />Is <br />P B. Trans -after 2 Acknowled amens of Receipt of Materials - <br />1 <br />Printers /Typed Name Sig oto M.vnrh Day Yevr <br />E <br />R <br />19, Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />net or O aerator Certifica6a of receipt o hazardous materials covered b this manifest exce t a noted in Ite <br />ri f /Typed oma <br />Signature MonPh Doy Year <br />Y <br />l DO NOT WRITE BELOW T LIN <br />PR L A )0002289766 <br />SMFL A) 0040128365 Whi e: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br />DTSC 8022A 1f991 To: P.O. Box 3000, Sacramento, CA 95812 <br />EPA 8700-22 <br />