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Slate of California, Heahh and Welfare A9ert <br /> 1ILMS No. {ExTtiry�a �! <br /> HUAR <br /> 1p <br /> MANIFt <br /> ASTE <br /> 1 ' <br /> X <br /> 4. tors Phone <br /> ... t•. . _ - t k- -. <br /> 5. Transporter.1 Company Nsnm r..-.. <br /> T Tranapon*r 2 Computy Na,ne, a r1�4 .A J Far � f� <br /> t t <br /> W D&AWated Facility Name and Stte Address a', 10. titsEPA'0 Numbir <br /> SAFETY -KLEEN e04P <br /> t YY t Iw ii Yf RLYD <br /> ..- .� :�.- i :.' :1 r •< -;.� 1,:.5 h4rg <br /> 1 �+ <br /> CAT 0004139,1fi <br /> Z SAL I DAF CA 95360 _ � <br /> LC 12. Containers tS.Total' 14. <br /> 0 it. 69 DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number?. CluantNy unit 6' Sts �. <br /> .I Na. TypeWt/Vol <br /> WASTE PETP15EEUR LLs <br /> = z a <br /> COMBUSTIBLE L I OU I D UNt 253(0001 ) (ERG #271 Da I � p <br /> C N <br /> �y E I] i - �,3i �-,�•1 'i^ rrs - e ,'l �. ���.yay } :7`'_ 'te✓) r1 :: <br /> R rr q r.t i, SyS' H S' .+r 0.i '_ <br /> � <br /> K. `SrY <br /> µ¢j d. state d. <br /> EPiQdhar <br /> W <br /> Z pJ. Additional D�escriptloria for Materials Listed Ab" wk',^�s> �+(� t it andprtQa logftVl( fayt4$Q . Iy, , .4 <br /> a i(A) „ <br /> i <br /> as fir,: ` ;i�r ter . +`��„d'ary ON <br /> Q «� <br /> 16. Special Handling instructions and Additional Information <br /> 9108 X474 587144 7-10-01-30" 09 <br /> EMERGENCY RESP#1-708-888 -46W <br /> LU - <br /> SXDDT# A: 501 0: C: D: <br /> �j <br /> U <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are In all respects in proper condition for transport by highway according to applicable international and <br /> national government reputations. <br /> If 1 am a large quantity generator.I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> 0 to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently evallable to me which minimizes the <br /> >- present and future threat to human health and the environment;OR,if I am a smell quantity generator,I have made a good faith effort to minimize my waste <br /> o generation and soled the best waste management method that is available to me and that I can afford. <br /> PrintedlTyped Name slurs--� / Month <br /> w � GU/ /tri ,,/ !.y �/�/•r � �c�cyw---�"� "Gt -�,.�� i <br /> WT 17. Transporter 1 Acknowledgement of Receipt o1 Materiels <br /> R - <br /> A Printed/Typed Name Signature Month a er ! <br /> N <br /> t7 S <br /> P <br /> HOPI Thnrntnn <br /> w O 18. Transporter 2 Acknowledgement of Receipt o1 Materials <br /> N <br /> U R Printed7Typed Name Signature Month Day Year <br /> E <br /> Z_ <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 manif at except as noted in Item 19. <br /> T <br /> Y Printed/Typed Name Sipnatu Monfo Day e r <br /> Clark E. Hill <br /> DHS 8022 A(t 788) Do Not Write Below This line <br /> EPs%8700-e22 <br /> (Rev,9-88)Previous editions are obsolete. <br /> Yellow-. TSDF SENDS THIS COPY TO GENERATOR WITHN 30 DAYS <br />