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Slats of Califorrro--Environmental Protection Agency <br /> Fo,m Appm�d OMB Nor 2050-0039,(Expires 93re)94) `/ SCD Instructions on back of ./ 6. Department of Toxic Subsloncn Contra <br /> Please part arty". Force designed for use on elite(12-pitch)typewriter. Sazromento,Califorrda <br /> UNIFORM HAZARDOUS 1. Genera tar's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST 1 A=: 0 0 7 9 71 P 101 ,1F:1 5 u 1) 1 3 of 1 <br /> J. Generator's Name and Mailing Address L A. Slate Manifest Document Number <br /> o W.W. MILES 93553603 <br /> in P.O. BOX 1238, LOS ALTOS, CA 94024 B. State Gneralois ID <br /> 4. Genernlor's Phone (41 q 9.43-67 06 <br /> in <br /> __ __ _ <br /> 0 5. Transporter 1 Company Name b. US I'.PA ID Numbe. C. State Transporler's ID <br /> NnR 1_:AI_ OIL AD 9 32 17 2 55 <br /> D. Trans podia's Phone <br /> (209)0667-6692 <br /> 7. Tramped.,2 Company Name 8. US EPA ID Number E. State Transpoder'$ID <br /> Q <br /> U F. Transpoderi Phone <br /> cY)Q 9. Designated Facility Narne and Site Address 10. US EPA ID Number G. Slate Facility's ID �� <br /> C Z ENVIROPUR WEST CORPORATION �>3✓k�J� CIf I <br /> (Do 1'3331 NORTH HWY. 33 H. Facility',Phone 7 - <br /> C�Q F'ATTERSOtd, r_.R 95363 11-1 Fill I01 131 1 6 7 S lr� �j j� <br /> 12. Containers 13. Total 14. Unit <br /> Z i 11. US DOT Des-psion(including Proper Shipping Name,Hazard Class,and ID Number) No. T e Quantity Wt/Val 1. Waste Number <br /> .T NOTKI—F'CRA HA-10WASTE LIQUID !, — �q 23 <br /> �3 O (WATER DIESEL FUEL) V O1 T T / XC2 6 EPA/o her, <br /> mN b. State <br /> tNN R EPA/OBsar <br /> y <br /> O T c. Slam <br /> O <br /> R EPA/OBmr <br /> Zd— — — 2TA�A,'G'- c �GV Slate -.. <br /> w <br /> U EPA/OB., — <br /> W L1- <br /> Z J. Additional Descriptions for Materials Usted Above K. Handling Codes fa WasMs listed Above " <br /> O c. h <br /> c. WATER. APPROX. 95% <br /> DIESEL FUEL APPROXI: 5% <br /> Z15. Special Handling Insbudions and Additional Information <br /> P: APPROPRIATE PROTECTIVE CLOTHING JOB SITE: <br /> Z "EMERGENCY CONTACT: (209)667-6692" 1145 W. CHARTER WAY <br /> w SEE E.R. G. 31 STOCKTON, CA 95206 <br /> x <br /> Ib. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are lolly and accurately described above by proper shipping name and are classified, <br /> Gpoked,marked,and labeled,and weirs all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <br /> If I am a large quantity genem!oq ! cadif) that I have is program in place to reduce the vclome and `oxic'ty of wase 9enensted'o the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage, or disposal currently available to me which minimizes Bre present and future <br /> 1 threat to human heahh and Bre envirpmmant; OR, if I am a ..If quantity generator, I have made a good faits effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that 1 can afford. <br /> Q Printed T ed nature <br /> g Nome Si Manlh Day Year <br /> �tn m �uC77" d <br /> ZT 17. Trans oder 1 Atk owlechierivernt of Receiat of Materials <br /> wW A5F Prin / edJae nj12V <br /> Da <br /> C / y a <br /> 0 18 Trans der 2 Acknowledgement of Receipt of Materials <br /> w ItPrinted/Typed Name Signature MeathDay Yeor <br /> 0 E <br /> Q. e <br /> ,u 19. Discrepancy Indlcaricn cpn,e _— -- _— — <br /> Q <br /> F <br /> A <br /> Z I <br /> --- <br /> t 20_Fodlry Owner o Coeras Ce I c lire of l-Seciat of hnzardeus maser c ed by f s f n exc pt s noted n m 19 _ <br /> T Prnted/Typed Name--; r f _ Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8027A (9;93) _ <br /> EPA 870D-22 <br />