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State of Gilt n"--Health and Welfare Ag«rcy Departine t of Health Semites <br /> Fant Approved 000 No.200--0D39(F.rrpirtia 9-30- Toxic 8ebafteoes Control Dwisi st <br /> lstasse prwtt ortypo. (Formdeatgrted k w ase on*fife 7 ch fyp*+rrlfer). `—185—v 1MaamMtlR GLlortti� <br /> UNIFORM HAZARDOUS 1. Generator's US EPA 10 No. �.F• t wrtomattoa In*A too"ttr�as <br /> Docurnsilit No. <br /> WASTE MANIFEST (;AIjfM6 01 t.a°t I rg-WAV*d bV haderd x111' <br /> a- R I tYXW cR'"ROWERS PLNT T <br /> (6200 NDWELL RD <br /> HORNTON CA 95686 <br /> A. Genwator's Phone 249) 794-82303 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number .. .. oat <br /> SAFETY—KLEEN C ORP. ,?�'a"M <br /> N <br /> 7. Transporter 2 Company Name 8. US EPA ID Number #xr TrarrspoR*t�i n - <br /> _„_t ars Pl1prn <br /> g. Designated Facility Name and Site Address to. US EPA ID Number G State Fl t c ", vt <br /> gFETY—i�LlrEFd CORP. 7-1135-01 <br /> r _` YatD ,' ' <br /> �4 O SAL.I DA BLVD ti,Facmttr'a PttottR �� � w,.� <br /> 7 0CAT 0006 2 3968 <br /> h5 SAL I DA. CA 99368 = <br /> 12. Containers 1 <br /> 3. Total I4. <br /> ✓ 11. US DOT Description(including Proper Shipping Name,Hazard Class,and 10 Number) Ouantlty Unity a 1i0 <br /> No. Type WtlYoi ' <br /> I Stated e z r <br /> c� WASTE PETROLEUM NAPHTHA <br /> z G <br /> C0MVST1DLE LIQUID UN1255(1>001114ERA #27 ) DMP , <br /> E <br /> ER b. E <br /> T t E". <br /> ♦ O 4 <br /> C4 R C. <br /> :: of <br /> d. <br /> UJI <br /> (0 9ecriptions for Materials t:ls1e4 Above'. ,- � - '+ �',-, • t :���>~ �`�� z�� � <br /> r.. <br /> cc <br /> t <br /> - t .._ ., C_r, •s..{.'?6'1: ��t-r _. '"ruT'iT?';a a ,,,�,: ,.-y't _ !b! :. <br /> It Special Handling Instructions and Additional Information <br /> ` 9029 17436023 123499 7-1135--471-3877 01 <br /> z EMEROENCY RESP,41-705--898-4640 <br /> W <br /> BKDOT# A: 501 D: C: D. <br /> J <br /> J <br /> < 16. <br /> U , <br /> GENERATOR'S CERTIF)CATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping nam* <br /> j and are cleasified,packed,marked,and labeled,and are in an respects in proper condition for transport by highway according to applicable International and <br /> iL national govenunent regulations. <br /> M I ern a terga quantity gsrterator.I certify that I have a program N place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> to be economically predicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> >- generation <br /> and future threat to human health and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minlmize my waste <br /> U generation and select the beat waste management method that is available to me and that I can afford. <br /> lure Mon Q Y Y ar <br /> WW Printed/Typed Name - e <br /> cc W I[! Sr <br /> W, T 17, Transporter 1 Acknowledgement of Receipt of Materials <br /> Z R <br /> t A Printed/Typed Name Signature Mon D Year <br /> N <br /> o. s Noel Thornton <br /> 0 P <br /> W O le. Transporter 2 Acknowledgement o1 Receipt o1 Materials <br /> rcR Month Day Year <br /> U PriniedlTyped Name Signature <br /> E <br /> Z <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I 20. Facility Owner or Operaf Certlfication of receipt of hazardous materials covered by this manifest except as noted in hem 1g- <br /> TMonth Day Year <br /> Y Printed/Typed Na ms Signature <br /> 0181 lee <br /> DHS 8022 A(Ilse) Do Not Write Below This Line <br /> EPA 6700--22 <br /> (Rev.9-88)Previous editions are obsolete. <br /> Yekw: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />