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jSbte of C Mesenion Agency <br />Fang Apprewd = Ne. 9(Eepim 9-30.94) . <br />Fkse prig « type. F«m !or use on .k'r. (12p(kh.,ewrser. <br />Y <br />a <br />q <br />E <br />a <br />t <br />U <br />u <br />W <br />W <br />0 <br />W <br />F <br />W <br />0 <br />N <br />U <br />V <br />See Instructions on back r ige 6. Department of Toxic Substances Control <br />\e/ Sacramento, California <br />rp DO NOT WRITE BELOW THIS LINE. y/ <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DISC 8022A (7/92) To: P.O. Box 3000, Sacrame m, CA 95812 <br />EPA 8700-22 <br />' I. Generator's US EPA 10 No. <br />DOUS <br />UNIFOR AN�IFEST <br />Manifest Document N. 2. Pegs I Information in the shaded arses <br />is ant required by Federal law. <br />wA5 CAD 0 8 9 8 8 1 7 5 <br />9 8 1 01 6 1 of 1 <br />S. GerrMar, Nacre msd Mailing Address <br />AURORA BODY WORKS, INC. <br />446 N. Aurora, Stockton, CA 95202 <br />Geneon/al' <br />A G.eaa'.Phon. (209) 388X6 465-2636 <br />5. Transports, 1 Company Name 6. US EPA ID Number <br />G'Stote Troraporter`s ID / R <br />NOR CAL OIL IC IA ID 19 18 12 14 <br />11 17 1;D. <br />rromp«tsr, Phane 209 667-669(2 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Tromportcrs ID <br />F. Transperter's Phone - <br />9. Designated Facility Nome and Sits Address 10. US EPA ID Number <br />G. State Facility's_ ID -: <br />REFINERIES SERVICE <br />IC 1AD 10 18 13 1116 16 17 12 18 <br />13331 N. Hwy 33 <br />1 H. Facility's Phone <br />874-4444 <br />11. US DOT Description (including Proper Shi n Name, Hazard Class, and ID Number <br />P h gShipping ) <br />12. Conahers <br />13. Tocol <br />Quantity <br />la. ❑�u <br />Wt/Vol I. Warms Number <br />No. <br />Tvpe <br />a. NON-RCRA HAZARDOUS WASTE LIQUID <br />s"me <br />223 <br />G <br />(WATER & OIL) <br />01011 <br />T T <br />G EPA/tith <br />Ee <br />N <br />Is. <br />Se m <br />E <br />EPA/other <br />It <br />A <br />T <br />s. <br />Siete <br />O <br />11 <br />EPA/Oth« <br />R <br />d. <br />Stale <br />EPA/Other <br />I Descriptions for Materials Usted Above <br />K. Hurdling Cedes far Wastes <br />listed Above <br />ANK BOTTOM WASTE <br />b <br />SATE"= <br />d. <br />.>; <br />I5. Special Handling Instructions and Additional Information <br />APPROPRIATE PROTECTIVE CLOTHING <br />"EMERGENCY CONTACT: (209) 667-6692" <br />SEE E.R.G. PAGE 31 <br />16. GENERATOR'S CERTIFICATION: I hereby declare thal the contents of the coneignmeM aro fully and accurately described above by proper shipping name and are classified, <br />packed, marked, and labeled, and arc in all respects in proper condition for transport by <br />highway according to applicable federal, slab and international laws. <br />If I am a large quantity generator, I certify that I have a program in place to reduce <br />the volume and toxicity of waste generated to the degree I have determined to be <br />moramicolly 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 />threat to human health and the environment; OR, if I am a small quantity generator, I <br />have made a good faith effort to minimize my waste generation and select the best <br />wast mono einem method that is available to me, and that I can afford. <br />Printed/Typed Name Martin thorpe agent for <br />si9naarre <br />--7°^lh�� <br />Year <br />Aurora B d Works Inc. <br />9 <br />T <br />17. Transporter I Acknowledgement of Receipt of Materials <br />R <br />N <br />Printed/Typed Name / <br />Si9naare <br />Ido Day ear <br />S <br />rV/Qs <br />C//� <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />T <br />Printed/Typed Nanta <br />Sig r <br />Month Day Year <br />F <br />R <br />19. Discrepancy Indication Space <br />Is <br />A <br />C <br />1 <br />l <br />20. Facili Owner or Operator Certification of recei t of hazardous materials covered b this manifest ..c.pt as noted in It.. 19. <br />T <br />Printed/Typed Name 5igmluro <br />Monts Otey Year <br />Y <br />Gi f %{ n <br />% <br />rp DO NOT WRITE BELOW THIS LINE. y/ <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DISC 8022A (7/92) To: P.O. Box 3000, Sacrame m, CA 95812 <br />EPA 8700-22 <br />