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Stara of Colitmak -En imarmetal Protection Agency <br /> Form Appmw,d LMB No.2050-0039(Expires 9409A) See Instructions on back age 6. Dopamwm of Toe's Substaeces Casal <br /> noes Fame eprint or type. Fadesigned For use on of"(129iAeswiter. Sacramento.California <br /> UNIFORM HAZARDOUS 1. C»neratoran <br /> s US EPA ID No. Mifed Doc neem No. 2. Page I Informrea <br /> a8on in the hodd as <br /> WASTE MANIFEST C A D 9 8 1 6 9 6 4 2 0 0 2 1 5 2 1 d 1 a ml required by Federal law. <br /> 3. Generator`F Name and Mailing Addrn L <br /> Is toc k+W Stec rHe Ore, Jc) <br /> 3ooSIV A?M rR rl. [c,K-k Ga 9 6208 <br /> V) A. Ge erolors Phan. ( <br /> [S S. Transporter 1 Company Nam 6. US EPA ID Numbw <br /> °D PRC 981696420 <br /> Q7. Transposer 2 Company Nam. 8. US EPA ID Number <br /> U <br /> < 9. Desi noted Fodr. No end Site Address 10. US EPA ID Number ,'Y Stote' <br /> "M PIC PrISI SON <br /> No 13331 1V. HWY. 33 <br /> V-1— PATTERSON, CA 95363 F JA P 10 18 13 11 111 16 7 12 18 <br /> M< <br /> U 12. Comainen <br /> I,. US DOT Dawiption(nd dmq Proper Shipping Nama,Hazard Ooss,and ID Number) - 13. Talal - 14. Ilam <br /> -�3 NO. 'Art/Vol <br /> G NON RCRA HAZARDOUS WASTE LIQUID 0 0 1 T T d G <br /> i V <br /> m N b. <br /> m E <br /> a <br /> v R <br /> S T <br /> T <br /> O <br /> Of R ¢. <br /> W <br /> z d. ?- <br /> W <br /> V <br /> N .EP..JORer <br /> Orex.A ".ior Moteno taMjd„A�bawrxiw ,y 'F' ` Codeciar wanes�liived �w ', <br /> ':`S � ,��„' Vii,. <br /> n <br /> t <br /> O 15. Special Handling Wtmctions and Additional Information <br /> F " <br /> < OILY WATER <br /> z <br /> W <br /> 2 <br /> 16. GENERATOR'S CERTIFICATION; I hereby ch"m that the contents of the casignmat on fully and accam ely deunbed above by proper shipping name and an classified, <br /> < pocked,marked,and labeled,and an in all respecte in proper condition fa sanrpat by highway according to applicable federal,caro and inte motional lows. <br /> -. If 1 am a large promity,generator, I codify that I haw a program in plan to reduce the s I..and toxicity of wase generated to the degree I haw dearmi ed to be <br /> soomea Golly practicable and that I how selected the practicable method of tregbn.rd,storage,or drsporal currently ovalablet a m.which minimises the present and future <br /> N throat to humans health a"the emiroan.mt OR, B 1 mm a small quantity genmone,I haw mode a god faith effort to midmbe my ware generation and select the best <br /> a, ware nmemagamend method that is aw8oble to me and that I can aHard. <br /> O Primd/Typed Noma _ Siq n ` Month Day Year <br /> 2 G 2 <br /> Z T 17. T 1 Adsnawkd emento/off�Recei of Maleriols <br /> .f Printed/TYped Nom / `♦ a SgmNro _ / 'DoyD r <br /> C N FAhA�.flvLI- <br /> W e <br /> 0 18. Tromparter 2 Acknow ml emem of Receipt of Mot.rioh <br /> W t Priated/Typd Name Siq n Month Day Year <br /> W <br /> O i <br /> N19. Discrepancy Indication Space <br /> < F <br /> U A <br /> Z � <br /> _ I <br /> L <br /> ,y 1 20. Fxl' Ownar w rotor Certification of rocei of ha:ard.e material,covered this manilas tompt ce noted in hem 19. <br /> T Printod/Typed Ham. SignaNro Month Day Year <br /> r <br /> DO NOT WRITE BELOW THIS UNE. <br /> Blae: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DISC 8022A (12/91) To: P.O. Box ADO, Sacramento, CA 958124" <br /> EPA 8700-22 <br />