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Stare al Califomio--Enwmmumld Prosection Agency <br /> Form Apprewd OMB No.2030-0039(Expires 9-30-96) �� See Instructions Ofd back o\�e 6. Department of Toxic Substances Cardec <br /> Herne print o:type. Farm designed for ase on dire(17pi ch)NPewMar. Sacr.. ,California <br /> UNIFORM HAZARDOUS 1. Generotor's US EPA ID No. Manifest Document No. 2. Page 1 nformatim in the shaded areas <br /> WASTE MANIFEST L' I i) i 1 C ^6 '3 4 3 D 1 7 of 1 s rot squired by Federal law. <br /> 3. Gemrato/s Name and Mailing Address A. Seems AMeilest Document Number <br /> voi POLAR WATER COMPANY 95232017 <br /> 1629 W. FREMONT ST. , STOCKTON, CA 95263 B. State Generatalf ID <br /> ul 4. Generalo/,Phone (20? 466-6766 <br /> 3. Transporter 1 Company Nome 6. US EPA ID Number C. State Tromporle(s ID � •L�: <br /> 1° NOR CAL OIL C AD 9 82 4 17 2 55 4: <br /> D. Tramporlels Phase <br /> (269)667-6632 <br /> Q7. Tromporder 2 Company Name 8. US EPA ID Number E. State Transporbls ID <br /> U <br /> F. Transports/,Phase <br /> Q <br /> 9. Desi staled Fa<il'rrvv Name and Sife Add en 10. US A ID Number _ G. Stab Fadlify's ID <br /> O Ci--.A+T ioe6i P(ZL 4 S W I P/ , <br /> <A r e 0083 G7 Z <br /> W 13331 NORTH HWY. 33 <br /> H. Facility's Phone <br /> a PATTERSON, CA 95363 1 I' D ' ji27 97Y-5'E/C/01 <br /> CV U <br /> M Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Namber) 12. Consumers 13. T Unit74. Un <br /> No. Type Quantity Wt/Vol L Waste Number <br /> Nt= NON-RCRA HAZARDOUS WASTE LIQUID Sts a,A2) <br /> Ln 3 (WATER & SLUDGE) 6 01 T T G <br /> N V+ EPA/Other <br /> o E <br /> mN Is. Stade - .. <br /> v E <br /> < R - - EPA/Other <br /> g A <br /> m T <br /> O <br /> W R EPA/Other <br /> z <br /> Z d. SIaIc <br /> W <br /> U <br /> dy EPA/Odlw <br /> Qz <br /> L Addii Description for Materials listed Above K. Handling Codas for Wastes Listed Above, <br /> zTANK BOTTOM WASTE d b. <br /> RINSATE e d <br /> zz <br /> 0 15. Special Handling Instructions and Additional Information <br /> APPROPRIATE PROTECTIVE CLOTHING <br /> z "EMERGENCY CONTACT: (269)667-6692" <br /> F SEE E. R. G. 31 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described abow by proper shipping nems and am classified, <br /> Q packed,marked,and labeled,ad are in all respects in proper condition for tr omport by highway according to applicable international and rational gowmmmn regulation. <br /> U <br /> If I am a large quantity generator, I certify that I how a program in place to reduce the wtsme and toxicity of waste generated to the degree 1 how °,''f/nmated b be <br /> monotonically—y onomically practicable and that I haselected she practicable method of heahnent,storage,or disposal currently asvilable to me which minimizes the przonf and future <br /> N threat to human health and the eneirormenb OR, 9 1 am a small quantity generabr, I haw made a goad faith effort to minimize my waste generation and select the bast <br /> O wash method that is awBable b me and that I can afford. /day l�Y/pr <br /> Prfntad/Typad NomeSigneure / Month 4 O 4 <br /> � Wtl -INEL- C? <br /> Z T 17. Transporter 1 Aclusawledgermsom of Resents of rials <br /> W R <br /> o: A Pdered/TYtxd Sf9neure Meeh Day Year <br /> S 3 <br /> P 18. Trampar amps of Materials <br /> W O <br /> R Prime /Typed Name Signature Meath Day year <br /> LL T <br /> O n <br /> N 19. Discrepancy I dicat e.Space <br /> U F <br /> A <br /> Z C <br /> 1 <br /> L <br /> 1 20. Facility Owner or Operator Cmtffkation of receipt of hazardous materials covered by this manifest ceatas noted in Iten 19. <br /> T Primed/Typed Name Signature Mash Day Year <br /> DO NOT W E O HIS UNE. <br /> DISC 8022A (9/94) <br /> EPA 8700-22 White: P.O. SENDS ENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> Ta: P.O. Sox 3000, Sacramento, CA 95812 <br />