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'U;,' Api,--1 uMb N. [:.��-iil.J:+{L-pars y Ji. y 1) 1Uac SuGslanCr, C.JnI�: DnSii <br /> Plea**print or type {Form designed for use on 12-pdch typew tior) 7-1 A`J�G 1 Sacramento,Californ <br /> UNIFORM HAZARDOUS Generator's US EPA tD No. Manche 2. Paye 1 Information in the shaded areas <br /> ♦' WASTE MANIFEST i °OeYT71 iant NO' is not required by federal law. <br /> 54 1 <br /> 3 Generator's Name and Mailing Address A. Slate Man 9999M3 <br /> I'Vorutnen <br /> LY <br /> TRI VALLEY- CROWERE' PLNT T 26200 NOWELL RD <br /> THORNTON CA 95+686 B. State Generator's Io <br /> It Generator's Phone( 204 794-2303 <br /> S1 5 Transporter t Company Name d. US EPA ID Number <br /> in i G Stat•Tranaporter's Ip 100105 <br /> ~ �, D. Transporter's Phone <br /> (V r 1 <br /> 09 n4s—init <br /> m 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> F- Trsnsporter's Phone <br /> 9 Designated Facility Name and Site Address 10, US EPA 10 Number G. State Facility's ID <br /> --JjI SAFE-TY-u LEEN CORP. 7-165 -01c A 6 8 <br /> 1 I <br /> 5050 SAL I DA BLVD H. Facility's Phone <br /> V) if CAT 0006 39 8 <br /> .0 <br /> n0 12. Conlainera 13, Total <br /> LL i 11. US DOT Description(Including Proper Shipping Name.Hazard Class. and ID Number) Quantity Unit Waste No. <br /> V a No. Type 1Wt[VOI <br /> " v a WASTE PETROLEUM NAPHTHA state 741 <br /> `J) � G COMBUSTIBLE, LIQUID UN1255� D001 Y (ERG 027) Q P EPA/Other <br /> . 3 E b. Q D001 <br /> ry R State <br /> A <br /> T EPA/Other <br /> O <br /> v R c. <br /> g State <br /> ori <br /> EPA/Other <br /> Q <br /> d N07 ICE: IN ACCORDANCE WITH 40 CFR 268- 7. THE %ENE RATOR PROVIIAV NOTICE <br /> W THAT THE WASTE DESCRIBED AS 'WASTE PETRO UM AP THA ' IS A <br /> RESTRICTED WASTE. THE WACSTE CONTAINS THE F L I G 8 I TUE"MOSE <br /> OgE <br /> LU <br /> WJ. AcI for t v Wastes Listed Above <br /> Z <br /> a a. b. <br /> rn <br /> LU <br /> S e. d. <br /> Z <br /> Qi <br /> f—I 15. Special Handling Instructions and Additional Information <br /> ' <br /> z 021 15705577 40"1'754 7--185-01 —:3077 01 <br /> U EMERGEN Y R SF'41-748-866-4660 <br /> J <br /> SKDOT# A: 501 B 1U p <br /> Q t6 <br /> Ui <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are sully and accurately described above by proper shipping name <br /> -a <br /> and are Classified,packed,marked.and labeled,and are in all respects in proper condition for lienaport by highway according to applicable inlernationai and <br /> national government regulations. <br /> If I am a large quantity generator.I cerlity that I have a program in place to reduce the voJume and toxicity of waste generated to the degree I have determined <br /> p to be economically practicable and that I have selected the practicable method of treatment,storage.or disposal currently available to me which minimizes the <br /> present and future threat to human health and 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 that is available to me and that I can afford. <br /> z <br /> tu Printedr a,,I78 <br /> Signature <br /> fa <br /> / �/" Month Day Year <br /> LU 7 <br /> MW R 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> Z A Ponted l Typed Name 5i nature r <br /> �fi <br /> Q N 9 Month Day <br /> OI P Noel C <br /> w O 18 Transporter 2 Acknowledgement o1 Receipt of Materials <br /> V) R <br /> U! T Printed^Typed Name Signature Month Day Year <br /> I E <br /> Z! R <br /> _ l <br /> FC <br /> t9. Discrepancy Indication Space <br /> I <br /> L <br /> LYT <br /> 20. Facility Owner or Operator Certification of receopl of hazardous materialscovered by this manliest a cepl as anted in Item t9. <br /> PrintedfTyped Name <br /> S <br /> --- <br /> Clark . Hill ignature Month Day <br /> 7L �� <br /> DHS 8422 A(1188) Do Not Write Below This line - <br /> EPA 8700---22 <br /> (Rev.9-88)Previous editions are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR W MN 30 DAYS <br />