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1, r"'�Q 6. Department of Toxic Substances Control <br /> State of California--Environmental Protection Agency Sf:B IhstTuetton on bock of Tf1 <br /> Form Approved OMB No.2050-0039(Expires 930-99) Sacramento,California <br /> please print C?type. Form dasigned for use on elite{F 2-pirchfk 'r. <br /> ' nerasor's US EPA ID Ho. Manifest Document 1 2. Page 1 Information in the sftnded-areas <br /> t UNIFORM HAZARDOUS � is not required by Federal law. <br /> 8 5 <br /> WASTE MANIFEST D T' , C {p - of <br /> ,' 1Nti(�' A. State Manifest Document Number 2^ <br /> 8565-67 <br /> 3. General4�,s Name and Mailing Address 3 <br /> U d�i�-f'c o W to ^F1rt c U G- 0-& WLS bl6e,i-h 4 <br /> &vrit'}'1G�� r Ot B.State Generator's ID <br /> O <br /> 6567 <br /> s[y A. Generator's Phone( Z,'a} <br /> h 6. US EPA ID Number C. State Transportee3 ID[Resenred.j <br /> 5.'Trans orter 1 Com any Name <br /> LO Sal! 4Qfliii� I!'z@C IteC�'CLbi€' D. T <br /> (559)493-€1240 0 .. -0240 <br /> d S. US EPA ID Number E. State Traniporter's ID I erved.j <br /> m 7. Transporter 2 Company Name - - <br /> f i..Transparter'a.Phone , <br /> J <br /> U 10. u5 EPA ID Number G Stata'F.iIi 's ID <br /> n 9. Designated Facility Name and Site Address aW51 V <br /> a `Parker Facility-- .14287 <br /> E. Manning � Facility's H. Faciki s Phone <br /> o Pa?;li ; Ca. 93648 2 7 (559)498-0140 <br /> 1 - 12. Containers 13, Total 1 A, Unit <br /> Y)Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number), No. Type Quantity Wt/vol 1, Waste Number. <br /> V Z State <br /> a. <br /> Nan-RcRA Hazardous Waste Uq d(Used Oil) :D EPA/OLA <br /> 3 G <br /> E <br /> State <br /> o N b_ <br /> m E EPA/Other <br /> d R <br /> CT" A r. State <br /> mEPA/Other <br /> R <br /> a State <br /> W <br /> f- <br /> Z EPA/Other <br /> LU <br /> V <br /> sis K. Handling Codes for Wastes Listed Above <br /> N 1. Additional Descriptions for Materials Listed Above <br /> Lu <br /> Q <br /> 0 115- Special Handling Instructions and Additional Information <br /> WTA-9 PROT'EGTNE 4,i OTI-E G ENMRGENCY RESPONSE: <br /> Z W G-cCCV4.:� San'Joaquin (559}498.0240 <br /> LILA {1-40 1"CL OU <br /> zoi <br /> a 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by per shipping name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations- <br /> -J+ If t am a large quonlity generator, I certify that I hove a progrom in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economitaliy <br /> ti practicable and that 4 have selected the practicable method o treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have mode a good foith'effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can°Fiord, i <br /> - OPrinted/Typed Name Month Day Year <br /> V Ui l 9 . <br /> Z <br /> ssu T 17. Trans irler 1 Acknowledgement of�Recei of Materials <br /> ,) Month Day YearLU A <br /> Pr' typed Name E � Sign e d/ r C <br /> w S L aff+••yC�G} <br /> P <br /> 0 a18. Transporter 2 Acknowledgement of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> tv E <br /> � R <br /> U 19. Discrepancylndication Space <br />' Z F <br /> A <br /> C <br /> I 20. Facili Dwner or Operator Certification of receipt of hazordous.motarials covered 6 this manifest except as noted in Item 19. <br /> T Printed/Typed Nome Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS .LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A 11/99) To: P.O. Box 400, Sacramento, CA 95812.0400 <br /> EPA 8700-22 <br />