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State of CaNforrla—HsaRh and- fif4rfl T Bch tyae;+►ftr). drliQ.�aC4f19�8 8 Q° p *of <br /> Form Approved Omp 2� '3 r s fi s� $Sq Iflstructf <br /> ,I��r e <br /> .Please prird or type °" ;, ,; ' k r, <br /> to isrl P <br /> O <br /> UNIF0R USE' Ger"r°,a'.Us EFA m.No. <br /> WAST Ai ,< A M'AW17 <br /> yL `fie <br /> - a. erato lne a Addy°ir PLNT T r t , , <br /> 'z <br /> 7' ay '> -ray CA 9��aSb e. <br /> 4. GensratOr'a.PhlMfl �. T��'2wi1/+7 .��^'�"t �"�* ... d�,i. � 3., <br /> a d. Transporter 1 Company Noma d. US EPA N Nttmbttr. .0 } .Y� <br /> ASF i4L N �QRt�. gAT 99011IM601A ' V r, 1�it <br /> ' 7. Transporter 2 Company Name 8. US EPA 1D Number = <br /> v <br /> E4„7tafispor�ara � :r } �' <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number . .. <br /> -� SAFETY--KLEEN CORP. 7-185-01 <br /> 5050 SAE.I DA BLVD. Pnorsa <br /> �#r • <br /> 'PO $OX 555 CAT 000613'x. <br /> Z SAL I DA, CA 95368 ; <br /> 12. Contoliners 13. Total 14. <br /> O <br /> 0 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and tD Number) Ouanttty Unit �WeAte No. <br /> No. Ty" W11 Vol <br /> d riaa. W.AST1E PETROLEUM NAPHTHA k state 741 <br /> ;fix G COMBUSTIBLE LIQUID UN125:1=01 ) (ERA #27) DM <br /> 1 EPAICMiurQQ <br /> E <br /> N G <br /> C�o E b. _ State <br /> A <br /> cv A a Stats �•> <br /> EPAlt <br /> T <br /> SC <br /> F d. State <br /> 2 - <br /> U EPA10ther <br /> N I J. AddWonai Descriptions for Materials Listed Above K. klendlln9 Codes for Wastes Listed Above <br /> Z yx • A <br /> ) D039 D016 <br /> a. <br /> AND OV <br /> rE Cd. <br /> Z kr r <br /> O <br /> C 15. Spacial Handling Instructions and Additional Information 9125 27926'342 319.x,99 7-18,e 01-3077 01 <br /> z EMERGENCY RESP#7(18-8 -4660 2.4HR 3/ I v�7'� ! <br /> Lu <br /> S%DOTO A: 501 D: C: D: <br /> J <br /> J GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuratety described above by proper shipping name <br /> J and are classified,pecked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable intematlonal and k.. <br /> l national govemmel,7eguiations. <br /> If I am a large quanf#ty generator,l certify that t have a program In place to reduce the volume and toxicity of waste generated to the degree f have determined <br /> to be economicaffy practicable and that I have selected the practicable method of treatment,storage.or disposal currently evadable to me which minimizes the <br /> O present and future threat to human health and the environment;OR,if I am a smart quantity generator,f have made a good faith effort to minimize my waste <br /> } generation and select the beat waste management method that is available to me and that I can afford.. <br /> U <br /> ui Printed/Typed Name SignatureMonth Day Y a <br /> WT 17. Transporter 1 Acknowledgement of Recaipt of Materials <br /> R <br /> t A Prinled/Typed Noma Signature / Month Day Y <br /> l� er <br /> 5Noel ThorntonThornton �i/p /// I <br /> Ip0 18. Transporter 2 Acknowiedgemem of Receipt of MatenatsCn <br /> _ <br /> FPrinted/Typed Name Signature Month Day Year <br /> Z <br /> E <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this m nifest except al noted in Item 19. <br /> T <br /> y Printed I Typed Name Signature nth Day Year <br /> Tam Perez <br /> DHS 8022 A Do Not Write Below This Line <br /> EPA 8700-22 <br /> (Rev.B•B9)Previous editions are obsolete. <br /> Yellow; TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />