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State of Ca ifomia—}Isalth and Welfare Agency See Instructions on Back of Page $ Department Of Health Services <br /> proved OMB No.t sae grist or tips Farm do(Expires Wesilgined lor use an pffah tyPe+rrear 3Front oToxk Buhataeasa Cgatrd D1,401" <br /> see t f a T- L <br /> UNIFORM HAZARDOUS t. Ciularargra tis EPA to wo. Manifest Y. PeOa t Dw information in the.halal at" <br /> WASTE MANIFEST D t 7 or ; Is 00 regalred by Fadarel law <br /> �. <br /> 3 Oeneraft>ra Namo Ma)II Iddress <br /> TRtStan►IAaftlfast r, r �t <br /> UA <br /> ERS PLNT T266a NMIEUiiii <br /> < <br /> i <br /> TMORMTON CA 9 696 PUIV a to <br /> -r <br /> �s <br /> 4. Generators Phone(.20"A / 4-2303 <br /> 6- Transporter 1 Company Name 6. US EPA ID Number � : T ads ifl 1.32 <br /> Pltgne —1 ! <br /> SAFETY—KLfiEN CORP. T 3 <br /> N 7. Transporter 2 Company Name e- US EPA ID Number Q� E Stals Trfnlrpo*e@ 1 <br /> r Pholit! . . . <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Fags 10 <br /> SAFETY-KLEEN CORP. 7-185-016 <br /> v <br /> 5050 SALIDA BLVD x facilftysPhom <br /> ` Sf;t .iDAr CA 953b8 CAT 000613168209 545-lQ11 <br /> �z <br /> ..i Cr 12. Containers 13, Total 14. !- <br /> +i 11. US DOT Description(Including Proper Shipping Name,Hazard Class.and ID Number) Quantity Unit Waste No. <br /> J No. Type W1/Vol <br /> C3 c`i a WASTE PETROLEUM NAPHT"4A slat* 1 <br /> 0Z c COMBUSTIBt-E LYoun UN1255(D001 ) (ERG #27) Dti F <br /> n jE E EPA/Other D001 <br /> +� E b- State <br /> A <br /> T EPA/father <br /> K O <br /> N <br /> R State <br /> � e. <br /> EPArCither <br /> fr d. <br /> LU state <br /> N ' <br /> Z P.PAlothar <br /> U <br /> rW 1 Additional DeeariMlons for Materials Listed Above IL Handiktg codes for Wastes Listed Above <br /> a Y (A) D039 D019 .. <br /> 14 AND 81 b. <br /> LU <br /> lC d- <br /> = 16,.Spacial Handling Instructions and Additional information 9117 26150440 627890 7—L65-01-3077 01 <br /> Z EMERGENCY RESP#708-888-4660 24HR <br /> J <br /> J <br /> V 18. <br /> GENERATORS CERTIFICATION: I hereby declare that the contents of this consignm9nt are fully and accurately described above by proper shipping name 1, <br /> J and are classified,packed.marked,and labeled,and are in ail respects in proper condition for transport by highway according to apolicable international and <br /> Q national government regulations, <br /> +S If I am a large ouanMy generator.I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I*.eve determined <br /> O to be economically practicable and that I have selected the practicabis method of treatment,storage,or disposal currantly available to me which minimizes the <br /> preaeat and future threat to human health and the environment;OR,if I am a Smelt quantity generator.I have made a good faith effort to minimize my waste <br /> generation and select the beat waste management method that is eysilable to me and that I can afford. <br /> U <br /> Z <br /> W Printed/Typed Nam Signature Mocc <br /> nt <br /> r J// <br /> LU <br /> Wt7. Transporter I Acknowledgement o1 Receipt of Melenats �..y <br /> R <br /> Z A PrintedlTyped Name Signature Month Dav_ �r <br /> a r f']T <br /> U. NS Noel Thornton <br /> P <br /> w 0 18, Trananortpr 2 Acknowledgement o1 Receipt of Materials <br /> Q <br /> R T PrintedlTyped NSinature <br /> Name g <br /> Mr,>•rr DRQ' <br /> � E <br /> Zl <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 manifest except as noted in Rem 19. <br /> T <br /> y PrintedrTy sd Name Signature ^rw <br /> lark E. Hill / <br /> DHS 8022 A Do Not Write Below This Line <br /> EPA 8700-22 <br /> (Rev.8-89)Previous editions are obsoiete. , <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />