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Oct-29-2004 02:00 From-OUST SER1 <br /> 6 + T-169 P 004/004 F-255 <br /> _ f <br /> Slate of Colifarnia--Eaviraemenial Froteclion A@ en <br /> Four.Appra•rad OMA No.2150-0039lE.pires 930-991 See Instructions on 6ae{S of page.b. Deportment eFToxk 5u6raness Cannot <br /> Please prinl or type• form dos fined for use on elite f 12•pildrl typewriter, <br /> 5orrotnento,California <br /> UNIFORM HAZARDOUS I. Generator's US EPA ID No, FAanlfasl Docamort No. T7. Fag.1 Informelion in Ife shaded orerss <br /> WASTE MANTFESTIr is et required by Federal law, <br /> C A +7 0 O o ] a 9 S 3 ac <br /> 2. Generator's Nana and Mails ng Addrosa A. Std.manifest Document Number N <br /> ldealtlsalse of Stockton 2 <br /> 9737 S. Stockton Street <br /> on Stockton,CA 95206B. Stoe Gmaratar's ID <br /> A 4. Generator's Phone( 209 )9 4-t}l30f .1.1111-A l ti[�1 3 l g 1 Q l a 1 A]6151 A l <br /> C`t S. Transporter I Company Name A. US EPA ID Number C. Stare Frgn sposmr's ID(&served.] <br /> 40 <br /> m iii�l�tllt" 1=1'�brtfl:r ;r+t?, iF11 -r I?*":]1Pr.J�L�,^ylf`� D. Tronal:sorl.r'r P>t.na <br /> r, SS 24-16-48 <br /> 7. Tronspceter 2 Company Noma B. US EPA la Number E. Stow l�ansporrer's ID{fig rve .I <br /> C\j <br /> ,d„Q F_TronsF,otar's Phase <br /> 9. Designated Faulty Name and Site Address 10. US EPA 10 Number G. State FocllFlyl.10 <br /> Q ROMIC F_nvircnre%r�nt TaichnalogieSIIS A D Q £11914 1 5 121 61 51 7 1 <br /> %---i 2! 2081 F3ay Pool H, Fallily'a Phone <br /> .+ <br /> Q <br /> V 11. US DOT Description lindudine proper Shipping Nome,Hmard Clast,and ID Number) 12. Container. 13. Tesai 14. UnitNo. T aOucwnti�l rWt/Mol 1. Waste Number <br /> Z a. side <br /> = UtI1E: :eaulj:.ad 1.449tarfCFSr NgUid I4,Q S O ( 0 <br /> �g EPA/Olhar <br /> E NA 3082, POtIll, 4Q r.0ntalnS Ethylene Gl col- <br /> o N State <br /> m E EPA/Other <br /> c R J-1 A c State <br /> o' T <br /> O <br /> R EPA/Other <br /> ` d. Stale <br /> w <br /> U EPA/Other <br /> w �- <br /> In J. Additional Descriptions For Materiels Listed Above K. Handling Coda&For Was res Listed Above <br /> a Waste Sthyleaie Glycol 01 6, <br /> (Antifreeze) d. <br /> a <br /> 0 15. Special Handling Instructions and Addiliond Irfarmarion <br /> a r�C)V;�S �atli P�cl't•;.•�:7i�.fR Ci�th3trrg CfxsergeT-r.yr �E•S�t"s11:�a �Il?�:iaiE?s �r�Q,r �'rin�t�+�l$ <br /> z <br /> LU 11140 I i1C Proftie O i+oi l i-v Emergency FRespon�l;e GUide 3000 0171 <br /> M <br /> t- <br /> z+ 16 GENERATOR'S CERTSICATION: 1 h...by daelosm that rhe conlams of This consignment an fully and wcurahely dnal6ed a6eva by proper Aippint name and era classilied•poc6d• <br /> d mocked,acrd labeled,and are in all respects in proper condition for Iramporl by highway acessAng to applicable inlmrwlional and nalixal go ornmenI m eulalions. <br /> U <br /> r <br /> IF 1 am a large gaan9ipy ganerater,I certify that I have a proggram in place to reduce the vdoms and tonicity of wash genasased to the doges I have ddermined l0 6e economicallyy <br /> rL practicable and that l have teFaarod rhe rasticoal.method of tr.o manr,storage,ar dispawF currently availa6la 16 me whiel�rsin;nr::es she pro�enl and furor.threat to hunpn heahh <br /> w <br /> and Ihv ervironmenl;OR.if I an o va I quanilly generator,I have made g geed Faith oflort to minimize my waste generation and=t <br /> rho Fast wasto managemenl method that is <br /> zx <br /> Q available b me and War I can afford. <br /> } Primed/Typed arise 53 nalury Month Day Year r <br /> zPell W ZA:�r 0- <br /> w R 17, Trans stew 1 Acknowledgement of Recei t of Materials <br /> L5 S Printed/T ed Nama Sig of —�� Manch Duy <br /> w — <br /> sa_ p 1 B. tons orler Ackms. einem of Reeei r of Materials <br /> TPrintad/Typed Name gnalure Month Day Year <br /> ut E <br /> Q <br /> R <br /> V 19, Discreporce indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. FaciFl Owner ar O amtor Cortlhcofian of raeel of k=Ordan5 materials cavored this rnon last exn t as naiad in Rom 19 _ <br /> T Printea/Typed Not— Sienah1P—j Month Day Yeu� <br /> r � t <br /> DO NOT WRITE BELOW THIS LINE. <br /> ,, <br /> DTSc_8022A I I/991 J.- <br /> EPA <br /> :EPA 6700-22 <br />