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al Protection Agx�cy <br /> OMS No.1050-0079(Ergines""6) See Instructions on back c :7e 6. Depanmue of Tai Ulmmc«Comrc <br /> type. Porro d cipn.d for,w an etre(12,,", <br /> So ssweem.California <br /> UNIFORM HAZARDOUS 1. Ge vt of r.US EPA ID No. Manifest Docamem No. 2. Pape 1 Mo mat as In the shaded arem <br /> WASTE MANIFEST C A L 0 0 0 1 1 5 0 8 9 0 1 3 0 7 1 b not rewired M Pedcral law. <br /> of <br /> .T. Gtr<rab/s Noma and Imp Address A. sella Manifest Dacvnsem Nuprliei',?'ii <br /> r v�1 CO PRODUCTS CO ATTNL NEAL DAVENPORT <br /> P.O. 80X 90877 DAVENPORT CHEMICAL ° r <br /> r LOS ANGELES, CA 9 09 <br /> B. Sble'Ga a Gale Ip » <br /> n w <br /> 4. G.remice. some �1G ) 342-9:59 11111 — E F 3 6 0' b'S <br /> 3. Transporter 1 Company Noma 6. US EPA ID Numbs C. Shiro Transpon<!s ID ,\� i <br /> DILLARD TRUCKING, INC. CAD9 8 1 6 9 2 8 0 9 D- T'aappch'sPhOe (800)'=¢75_'1066 <br /> J <br /> J <br /> U 7.sAansporhr 2 Compary Name 6. US EPA ID Number E. Stale lraaporlels ID - <br /> 5 <br /> F. Tnomporse/s Phone <br /> C 9. Designated Faci iy Name and Site Address 10. US EPA ID Number G. 7it�s ID - <br /> CHEMICAL WASTE MANAGEMENT I '•'' <br /> 35251 OLD SKYLINE ROAD .r•. <br /> v KL'YTLEMAN CITY, CA 93239 C A T 0 0 0 6 4 6 1 1 7 H. FaoEysMae (209)'386-9711 <br /> Z I1. US DOT Description(sncludmll PMP-Shipping Nance.Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> No. I Twse Qua Wt/Vol I Vymte Nimsber <br /> o. PET'RCLi:UM HYDROCARBON CONTAMINATED SOIL) "P2r611 <br /> 3 G NOV RCRA HAZARDOUS WASTE SOLID <br /> m E 0 0 1 D T 0 0 0 y EPA[O1he <br /> CRA <br /> N b. SIV R <br /> r E <br /> It EPA/Other <br /> A <br /> a9 T <br /> O State <br /> R EPA/Other <br /> Z d <br /> V Stale <br /> N EPA/Other <br /> ZQ <br /> K. Handling Codes far Wastes listed Above <br /> w 11A) PROFILE #AJ 1420 ERGO 171 Is. .,. <br /> m l,' <br /> J <br /> Z c. d. <br /> 0 15. Special Handling Inshuctiaa and Additional Information <br /> dear P.P.E. (i.e., ru:,ber glcves, rubber boots, 24-iiour _'.iergelics Telephone#!: <br /> Z protective clothing, respirator, goggles, etc. ) <br /> W SITE: ARCO #03493 <br /> = 205 NORTEi CRIT STREET J :: 1G.7-112 PO4 09-30222 <br /> 16. GENERATOR'S CERTIRCATION: I hereby declare that the contents of this comign nest are fully and accurately described*bow by proper shipping come and arc classified, <br /> Q packed,marked,and labeled,and are in an respeck in proper condition for Man rt highway according pp gowmmem regulations. <br /> U spa by p v^a/' Grp b applicable international and national <br /> R I am o large quamiy,generator, I certify that 1 have a program in place to reduce the wl me and toeiciy of waste generated to the degree I haw determined b be <br /> o_ econanicalVy, practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and f rlure <br /> n threat to Kumon health and the enviroanent;OR, R 1 am a small quantity generator, I have mode a good faith effort Is, minimize my woste generation and select the best <br /> z wash management method that is available to me and that I con afford. <br /> `O Printed/Typed me Signature - r <br /> j " I Month Day Year <br /> t O b <br /> y R 17. Transporter I Ackrwwkd mem of R e) t of Materials <br /> YN Printed/Typed Name Signature MeathDay Year <br /> L t <br /> yP <br /> 0. 16. Tr r 2 Acknowled anent of Re .f of Materiels <br /> s. T Pnmed/Typed Nome Si9naure <br /> 3 F MorBh Day Year <br /> R <br /> u 19. Diseeeponey 1ndKmion Space <br /> A <br /> 2 F <br /> J A <br /> 7 C <br /> I <br /> L <br /> 1 10. FacT Ovmm or Operator Certification of receipt of hazardous materials cowred by this manifea except as noted in Item 19. <br /> TPrimed/Typed Name Signature Month pay Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> 3TSC 8022A (9/94) . <br /> :PA 8700-22 Green: TRANSPORTER RETAINS <br />