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State of California—Environmental Protection Agency Form Approved DMB No.2050-0039(Expires 9-3p-99) See Instructions on back of q Please print or type. Fo,m designed for use on elite(12-pitch)typ P Department of Toxic Substances Control Sacramento,California UN&ORM HAZARDOUS 1, ®rrator's US EPA ID No. Manifest Document ND. 2. Page 1 Information in the shaded areas WASTE MANIFEST is not required by Federal low, R 0 O Q 1 0 9 7 5 ] 1 ;� 2 �6 of 3. Generator'rjis Name and Mailing Address A. Slate Manifest Document NumberrJ"RXVf:L PLAZA q r� /} 7 7t:UU 3_ HARLAN RD. In O LATI KROPP. CA 95,920 B, Slate Generalor,s ID 4. Generator's Phone (Z it 9 ) 9 02_9 48 cy 5. Transporter I Company Name 6. US EPA JD Number C. Stale Trpnspartar's If}[Reserved,] OP D- Transporter's Phone 3$OLTJT1011° INC- �' 0 4 (800) 746-7449 OF 7. Transporter 2 Company TP Name B. US EPA ID Number E. State Transportor's ID(Reserved.) r. Q F. Transporter's.Phone V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID -c '-'R035Y & CSS ER`1P C71ir INC_ � W i6:20 W_ 17th 3TEER H. Facihty'sPhone 0 LGrTG BEACH, Cie 900!33 C n D G ,� 8 4 0 9 tG 1 ei f800j $275749 J U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit z a No. Type Quantity Wt/Vol I. Waste Number TA TER : DI 21E:L MIX State F- NON—RiCFLA HAZ.A,RDOU3 vJA3T.E, LIQUIL) G EPA/Other 'S E ►4 - 1, 10 co N b AB30RSEN713 s DIESEL State co E tvurr-rtir_r F 21 R EPA/Other A 1 li O T c Stale co O -- R EPA/Oilier c LU d. Slate Z u.r U EPA/Other ua J. Additional Descriptions for Materials listed Above K. Handling Codes for Wastes Listed Above © IIA—PROVI'LE #34289 b. „3 1115—PROFILE J c. d. Z O 15. Special Hondling Instructions and Additional Information .PPROPIAS'E PRVPE::rP1VE CLOTHING Z "EMERGENCY CONTACT: (800) 746-7449" 3 EE E-P2-ter. PAGE #E 171 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by per shipping name and are classified,packed, marked,one labeled,and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations J J If I am a large quant. generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economically V) practicable and that I hove selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health and the environment;OR, if I am a smolt quantity generator,1 have made a good faith effort to minimize my waste generation and select the best waste management method that is ce O available to me and that f con afford. }. Printed/Typed Name Signature Month Day Year w Z a (.5T 17, Transporter 1 Acknowled ement of Receipt of Materials ce R LU p Prinled/Typed Name Signet Month Day Year � R ) LU P �+ 0 18. Trans orter 2 Acknowledgement of Receipt of Materials R T YP Name Signature Printed/7 ed Ng Month Day Year w E R V 19. Discrepancy Indication Space Z F — A - C I L f 20. Focili Owner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19, T Printed/Typed Name Signature Month Day Year Y DO NOT WRITE BELOW THIS LINE. i DTSC 8022A (1/99) E,ue. GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. EPA 8700-22 To: P.Q. Box 400, Sacramento, CA 95812-0400 )