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State of California-Environmenml Protection Agency <br />Form Approved OMB No. 2050-00391Ezpires 9.30.991 See Instructions on back ^I Page b. Department of Toxic Substances Contra <br />print w type. Form deigned forum on elite ll2IF <br />' ,Plane writer. Sacramento, California <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA 10 No. torilest Docume <br />2. Page I <br />Information in the shaded areas <br />WASTE MANIFEST <br />A ) 0 5 <br />is not required by Federal low. <br />_....._ .__ ..____. <br />1' 8 1 5 <br />of i <br />3. Generator's Name and Mailing Address <br />STOCKTON METROPOLITAN AIRPORT <br />In <br />5060 S. AIRPORT WAY, STOCK'TON, CA 95206 raeneabr,lp ;_ t <br />h <br />n <br />3. Generabr's Phone)91463-471- <br />l f.1 i <br />h5. <br />Transporter I Company Name 6. US EPA ID Number <br />m <br />NOR CAL OIL C: fdD 'i 92 •1 1 2 55 � c »,- yxt �V1. <br />c <br />. <br />_ <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />V <br />—IS <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />SAYSIDE OIL II. INC. <br />V) W <br />ID 0 <br />210 EMCINAL ST. F e <br />e, err t <br />JQ <br />SANTA CRUZ. CA 9506•) 1C I AP I0 I ap 181'-P 1212" -"4 Ir 12 <br />V-) V <br />v <br />12. C. nine's 13. Total 4 Un t - <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Num6erl <br />No. 7 Quantity Wt/Vol ,Waste Humher-.- <br />�� <br />NON—RCRA HAZARDOUS WASTE LIQUID`;.''`: <br />3 <br />G <br />(WATER. °. SLUDGE) <br />0 01 <br />T T <br />G <br />EP, titer <br />E <br />m <br />N <br />b. <br />P <br />m <br />E <br />•,., <br />i <br />a <br />R <br />A <br />Te. <br />_..._ <br />.. <br />I&3 <br />4PPROPRIATE PROTEt_TIVE CLOTHING <br />"EMERGENCY CONTACT:r209?541-91.15" <br />3EE E.R.G. 171 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents; of this consignment are fully and accurotely described above by propership ins name and a re classified, packed, <br />marked, ad labeled, and are in all respects in proper condition for transport by highway according to applicable international and nationaPgovernment regulation. <br />If I am o large quant)y generator,I certify that have a program in place to reduce Rte volume and toxicity of waste generated to the degree I hove determined to M economicallyy <br />practicable and that I hove :alerted the ... icable method of treatment, storage, or disposal currently available to a- which minimizes the present and luta.. threat to human henhh <br />and the environment; OR, if I am a small quantity generator, I hove made a good faith effort to minimize my waste generation and select the best waste management method that is <br />available to me and that I con afford. <br />Printed/7yped Name Signal.Monts Day Yeas <br />.r.A .. ,/ -, F, t n 1! . "/ e . i I! I n I n 1 :_ 7 1 <br />Nome <br />Z F <br />A <br />C <br />L <br />I <br />T <br />Y <br />Signature <br />DO NOT WRITE BELOW THIS LINE. <br />Mont, Day Year <br />K? !. <br />Monts Day Year <br />Month Day Year <br />iC , M1 <br />DTSC 0022A 0/971 Green: TRANSPORTER RETAINS <br />EPA 8700-22 <br />