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Jun 03 2008 2: 28PM COX BROS TIRE SERVICE 830401 p. 4 <br /> State of Colibmio--Environmental Profirdion Agency �%—1 Ejq. ^•01 - <br /> Farm Approved OM4No,2050.0039(Expire 9.30.991 See IOf{b11C1IOnf oil bOCIE o8e b. Ospadmant of Tozie Subsmnus Cont <br /> Please'printwlype.. Perm designed for use"etin,(12-pikh)typ~1W. Socmmenro,Cali(ornia <br /> 1. Generoror'e US FPA ID No. Manifest Deaum ml No. 2. Page 1 Inf«motion in IEe shadHdareos <br /> UNIFORM HAZARDOUS AD 34SZ1 Is not required by Federal`1". <br /> WASTE 'MANIFEST of <br /> 0 miatorh Name mod Mailing Addm .ef .a 1Fesi Doarment Nvmbor .. <br /> 41 E 11TH ST � � <br /> 'o TA' KY CA 05:376--4096 htnnD <br /> n <br /> A. Generator'.Phone 12051 B33' 0880. <br /> rCV S. Trcnapo r 1 Company Nam 6. USEPAIDNanber <br /> as SAFETY—KLE5N SYSTEMS, .INC <br /> °P 7- Transportw 2 Company Name I. US FPA ID Number 81afx ilid Ise el 1 <br /> " l' renapdgs r ; <br /> S Ea 'i nd - 10. US EPA ID Number '!8rtde f tl t <br /> 'INCGa 4 1 J <br /> i3 6400 88TH STREET <br /> >7a SACRAMENTO CA, 751a2e CAGO000€)4517 H, Fvsdiyslf <br /> I O <br /> .. 12. Comolnen 13. Total 14 Unit <br /> 11:US D07 Description Ilncluding Proper Shipping theme.Hazed Clan,ansd ID.16smbsrl No. Type Quamipy, WI/Vol +1$� <br /> 3 ° HAZARDUUS WASTE, LIQUID, 4. 0. S. DF . G b # ety <br /> �t � , <br /> 3 0 AWE00S (BRAKE SCILUTION'(6, :3#p/QAL.) <br /> b. <br /> m. E <br /> a A <br /> T t, <br /> O et' <br /> "g. <br /> d. <br /> w <br /> a <br /> r <br /> Z tI Y <br /> ne" S <br /> -- p chs r ,vu• x k=.• ,: o-" <br /> ,P� 409. <br /> as <br /> T a,: <br /> z4 A �4 `'91Cl�I4 �"°g7so 24fr <br /> 84S .4l1T6iESRIZ.ED. TD FtEFAIN .LTCEN$Eru` SL!'t3 EG{I1EPdI" CARi2SEf2a A3 1VECFS3RFtti". <br /> t <br /> A 039 B C 17 <br /> "J'_ 16. GEN9tATOR'S CBI701CAilONp. Iherebydslare lhpr lhecontenh of driscansignmentare fully and cotwoal�described above By prop«shipping nmwmd ors claWOed,p°absd,. <br /> VQ started,and lo all end an In aB respects In proper condi8on for transport by highway according bap Ip icable Immosiom and notional gonrnment regulations.:. <br /> IF 1 om�a large quonliy generator;(2erNiy Thal l Bae o pr�rom in place so reduce the volume and bxidyy of worse generated le the degree I hors caummirmd td Ifs economicallyY <br /> in. practicable and that 1 hove mlested flm praaiaabL metlmd of bealment,sbrage,«deposal eumnlly ovaiiabk ro me which minimum.tees prompt and future Ihraot m human hsalM <br /> and the enviram ";OR,01 am a small Qsonlily generator,I have mode a good frith effort b minimise my .,to generation and solve the best waste monagemem method that is <br /> O -available»me and chats con dffard'. <br /> y: PrinMl/Ty"d Nome Si r' re ,�Y <br /> V � d Month OoY Year <br /> W 13y*.> .e.. d s' ct o <br /> O T 77. Trumpseer I Actnovd sawn of Receipt Maleriab. <br /> WS R PrWest/T Name Signature., +/. MoMB Doy.. Yew <br /> O • 18, rams arisr 2 Actnowl ement of Raaei of Molerhb <br /> WPrinted/TYped SignatureNameSignature _ Month Day Year <br /> Qh R <br /> {� 19. Dixrspanryindication Space - - <br /> Z F <br /> A <br /> C <br /> 1 - <br /> t <br /> 1 1 20. FacilityOwner«Operator CertiRoaeon of reeei .1 hazardous moler:ols.covered by this moniFirt wat eased in Mem 19. <br /> T Printid/ltyped Nom Signmure <br /> Y A.11,A.11, Day Vwr <br /> DO NOT WRITEIIELOW �^ <br /> DTSC 8022A(1/991 - Blur GENERATOR SENDS THIS COPY TO DTSC WfiHIN 30 DAYS. <br /> EPA 8700-22 ' - - '- To: P.O:Box-400, Sacramento, CA 95812.0400 <br />