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F orm App,Lo 0Mb No 2050---XJ9(Lxpr+cs 9 7-1e5-01 AdilkTo..Subs! <br /> Please prml or tyPs. (form des,gned for uta on e! pitch typewrttor). 8>f p� ' <br /> on <br /> UNIFORM HAZARDOUS t- Generator's US EPA 10 No. Manifest 2. Pepe , tnrrxmafton N alta <br /> WASTE MANIFES' qAI 3 67 of I is nol regwred by Is>�sEi s <br /> 3 n rat r' A I Document Nwnlw <br /> A. Slate Manila <br /> yrF. <br /> 1� N T PLNT T pp ; <br /> 26200 NOWELL RD <br /> THORNTON CA 95686 e. Slat*Generatof'sID <br /> 4 Generalor's Phone f?09} 794-230' t . <br /> om, <br /> 5 Transporter t Company Name 8. US EPA ID Number C. State Transporter's lD F W 105 <br /> r. <br /> SAFETY -1A L.EEN CCIR P. A () Z 6` D. Transporter's Phone545-1-TI-1 <br /> N <br /> in 7 Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID + <br /> F_ Transporler's Phone <br /> 9. Designated Facility Name and Site Address to. US EPA 10 Number G. State Facility's ID <br /> SAFETY-KLEEN CORP. 7--185-01 C T 4 1 6 <br /> dC 5050 SAt I DA LLVI: <br /> CA1- 00061 3968 H. Facility's Phone <br /> -4a SALILA, CA 9-"-36P, 209 545-1011 <br /> 10 i <br /> ¢ 12. Containers 13- Total 14. <br /> V d 11 US DOT Description(including Proper Shipping Name.Hazard Class, and IA Number) Ouanrrfy Unit Waste No. <br /> No. Type Wt1Vol <br /> v a, wA� E P LEUM NAPHTHA State 741 <br /> CGS 11113UST1EILE L. 'IGUID UN12555(I'OOI ) (ERG #27 ) J, r, I`M,q����n P1( EPA/Other Do()Do()1 <br /> E <br /> � N tf ' l <br /> E b. State <br /> r4i R <br /> A <br /> �D T EPAJOthw <br /> v O <br /> R c. State <br /> g <br /> m <br /> EPA!Other <br /> W d. NOTJi.C. IN ACCORDANCE WITH 40 CFR 268. 7, THE (, =NE ATOR. PFSAl "NOT ICE <br /> Z THAT THE WASTE DESCRIBED AS 'WAST'IE PETROLEUM PH HA ' IS <br /> RESTRICTED WASTE. THE: WASTE CONTAINS THE I N CON T I UEN 'WliQ9E <br /> LU T <br /> Z J. AC MP 1,#1t TWA .a�s. K. Handling Codes for Wastes Listed Above <br /> a. b. <br /> O <br /> ran 14 AND 01 <br /> lu r C d. <br /> O <br /> 15. Special Handling Instructions and Additional Information 9025 1650949(7 751566 7-185-01-3077—3077 01 <br /> Z EMICR ENCY RISP#1-705--8438-4660 <br /> LLJ <br /> F- SKDOT# A: 501 0: C: R: <br /> J <br /> J <br /> C 16. <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 /> 0. national government regulations. <br /> cc 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 hove determined <br /> C) 1.be economically practicable and that I have selected she practicable method of treatment,storage,or disposal Currently available to me which minimizes the <br /> present and future threat to human health end the environment-OR,it I am a small quantity generator.I have made a good faith effort to minimize my waste <br /> U generation and select the best waste management method Shai is available to me and that I can aHord- <br /> Z <br /> � <br /> �=X <br /> NSig tura t Dayf <br /> w <br /> W A/L <br /> T 17 Transporter t Acknowledgement of Receipt of Materials <br /> R <br /> C A Printed: ry Typed Name SignatuM n! quay ryes <br /> LL �opl Thornton <br /> O P <br /> W O 18. Transposer 2 Ac*nowledgement of Recerpl of Materials <br /> q R Prrnled:Typed Name Signature Month Day Year <br /> U E <br /> Z R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 120. Facility Owner or Operelor Certification of receipt o1 hazardous materials coveredit�y this manrfeel except as noted in Item 19. <br /> T rr� <br /> Y Printed"TYPft�arK lii I I Signa r "f Mo h ay Y <br /> 1. � <br /> DHS 8022 A(f 188) Do Not Write Wow This Line <br /> EPA 8700-22 <br /> (Rev.9-88)Previous editions are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />