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i <br /> Sit 1.of C44.drio—Eneronemno l N.IK1IM Agent' " See Instructions on back A`19 a 6. <br /> I.,.Approved OMB 1 No.2050-0039(E.piret 93094) %rn epm-lm ml of Toxic Substancm Conaol <br /> "lease prat or type. Panes designed I.,uw on elite(12141h)gpewr0-1 S."cia enfa,Coliform. <br /> 1. Generator',US EPA ID No. Manifest Document No. 2. Page 1 Inlormolion in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST lol6N ICAS j 7 5 9 1 5 011 <br /> 3. Coastator's Name and Mailing Add.... A. State Manifest Document Number ..... <br /> ' <br /> N W,W, MILES Qo. IZ,92 ��5 HLfo� 64 `1�102ZI , 92867595 <br /> 7-r G I,� rlr r ij," B.Slate Generator's ID <br /> f` <br /> 1. -ma-let's s Phone (y IS 4 7o <br /> its3. Transporter 1 Company Name 6. US EPA ID Number C: Stab Transporter s JD <br /> NOR CAL OIL C AD 9 82 4 17 2 55 <br /> D.Transporter',Phine tr�20.9 Y667-669 <br /> Q7. Trompor 2 C2 Company Nome I. US EPA ID Number E: Stab Transp mire,ID VI?Is <br /> U F. Traasposles't Phone <br /> 5 9. Designated Facility Nome and Sib Add.,, 10. US EPA 10 Number G SlobInFa1cpili�ty''ns ID ,Q�2 <br /> ENV I ROF'UR WEST CORPORATION ` 7Y w10 I v N <br /> CY)0 13331 NORTH HWY. 33 H. Facgi y[Pna <br /> rZ PATTERSON, CA 95363 C PID 101 3 i E6 7 `8 �G�� <br /> U 12 Containers 13. Total 14. U t - <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Tce Quantity WI Val LAY A.Number-.,tet n""• <br /> O17r NON—RCRA HAZARDOUS WASTE LIQUID St°�23;1 <br /> N3 0 01 T T G EPA{O her <br /> Q) � (WATER °< SLUDGE) , <br /> m N b' state :"(- <br /> w <br /> N R EPA/OthaCSt:._ <br /> Y A <br /> A y9tate r ' w t} ♦. <br /> 3 c. lis Pie 1 . <br /> R aft , >r.:.;teX <br /> w g.1 <br /> Z d. <br /> W +3t� I�!t` <br /> rqtete <br /> 0 1 Ad Iwnal Descript ons for Mester a1s listed Above K. Han'dling'Codes foi Wastes"listed A ;; <br /> ; TAN BOTTDM TE WAS ! ' a <br /> a 'T <br /> IIVSATE, +"''r'1"' f t' e. d _ t" .I <br /> 1 rl <br /> Q •` �.,: tete' , S*: ' tete. . <br /> Q15 Spedol H dl ng ro- t s and Add t I In(om ol'a <br /> a APPROPRIATE PROTECTIVE CLOTHI14G JOB SITE; INDEPENDENT TRUCKING <br /> Z "EMERGENCY CONTACT: (209)667-6692" 1145 W. CHARTER WAY <br /> = SEE E.R.G. 31 STOCK'TON, CA 95206 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the<ontenh of the consignment are lolly and accurately described above by proper shipping name and are classified, <br /> Q packed,marked,and labeled,and are in all respec"in proper condition for transport by highway according to applicable federal,state and international law,. <br /> U <br /> ,i If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to 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 the present and future <br /> fY threat to human health and the environment; OR, it 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the bast <br /> h <br /> a, wash management method that is available to in.and that l can attend. <br /> O Printed/Typed Name SigrwfureI Month Day Year <br /> U V 1 <br /> Z T I7. Transporter 1 Acknowledgement of Receipt of Materials <br /> A- Printed/Typed Name Signature Mon 'Day Ypar <br /> " JOE PUETT <br /> W ' <br /> 0 18. Trans ortm 2 Ackrwwled emenl of Receipt of Materials <br /> W T Printed/Typed Name Si re Month Day Year <br /> 0 <br /> I O e <br /> W 19. Discrepancy Indication Space <br /> N <br /> F <br /> U <br /> U q <br /> Z C <br /> — 1 <br /> l <br /> I 20. Facility Owner or Operator Certification of recei f of hazardous materials covered 6 This manifest axce t as noted is Item 19. <br /> T Printed/Typed Nome Signature 'l .N est. Day Year <br /> DO NOT R�E BELOW THIS LINE. <br /> DISC 8022A (7/92) :x tete -crr_man:o :tete 'x:112 <br /> EPA 8700-22 <br /> t <br />