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Stab of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9.30-99) See Instructions on back o,{ ige 6. Department of Toxic 5u6lances Control <br /> 6. Please print or lypz. Farm designed for use on elite 112-pilcNee order. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No 2. Page-71 Information in the shaded areas <br /> of required by Federal law <br /> WASTE MANIFEST <br /> V 3. Generator's Name and Mailing Address Zoe, , 7�40 e,'l("y I A. Slate Manifest Document Number 98 O 500268 <br /> I y�7 B1a � K 1�;'q cl 'Vo <br /> O Lo <br /> s' s/a p���� ^ B. State Generator's ID <br /> q 1 7 <br /> N A. Generator's Pho B9 )7 3 –O✓(�a <br /> rn <br /> N 5. transporter 1 Company Name 6. U$EPA ID Number C. State Tmnsporfar's ID <br /> m <br /> 1 �4 V LL OIL .r1 ' 0 0 Q $ 7 7 D. vansparter's Phone 800-732-4645 <br /> i4� <br /> O C Rsvnl4 •n s V 2v <br /> 0 <br /> i s.. 7. Transporter 2 Company Name B. U$EPA ID Number E. State Transporter s ID <br /> t F. Transporter's Phone <br /> Q <br /> U 9. Desirom d FociliName and Site Address 10. US EPA ID Number G. $lata Facility's ID <br /> i d NUUSTRIAL=VICE OIL CO,INC ti T C I A 01919141512 7 10 18 <br /> i700 S. SOTO ST H. Facility's Phone <br /> o LL , CA 90023 C IA ID 10 19 19 14 15 12 7 582-598-5577 <br /> 12. Containers 13. Total 14. Unit j <br /> 1 U 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) ..* No. Type Quantity WI/Vol I. Waste Number <br /> $fate 228 <br /> 111= NON RCRA HAZARDOUS WASTE LIQUID <br /> C3 G (OILY WATER) 00 1 T T G EPA/Other <br /> 4. E smf" <br /> c N b. <br /> m E EPA/Other <br /> f a R <br /> { s.. A c state <br /> o T <br /> m O EPA/Other <br /> W as, R d state <br /> Isees <br /> z <br /> w EPA/Other <br /> V <br /> I w <br /> � <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codas for Wastes listed Above <br /> `0 OILY WATER ' 1 01 b. <br /> N <br /> w <br /> m <br /> J <br /> Q <br /> fess,Z <br /> O 15. Special Handling Instructions and Additional Information <br /> a GLOVES <br /> W EMERGENCY PHONE 209-887.8857 <br /> 1 r 16. GENERATOR'S CERTIFICATION: Thereby declora that thecontents of this consignment ore fully and accurate)Y described above by propership ing name and.,.classified,packed, <br /> { U marked,and labeled,and are in all respects in proper condition for Transport by highway according to applicable international and notionaPgover°ment regulations. <br /> ` 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 ho be economic a11 <br /> d practicable and that I tears seleched the racticable method of treatment,storage,°r disposal currently available to me which minimizes the present and future threat to human fees, <br /> M <br /> h and the environment;OR,if I am a small quantity generator,I have made 41,aith ort to mini ize my waste generation and select the best waste management method that is <br /> ac available to me and that I can afford. <br /> OPrintd/TyameSigntlt D°y ^Y°°y.vtae Z –_ \ N"� c.C, / 7 (JY <br /> wT 17. Trans rbr 1 Acknowlecl emenl of Receipt of Materials <br /> w j Pri"led/Ty ame Signature fA�nlh� ,Qay/ ( 'e°(�� <br /> ' r W S ` a <br /> P <br /> LL 0 18. Trans orbr 2 Acknowled ement of Recsi 1 of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> W E <br /> Q g <br /> 6. U 19. Discrepancy Indication Space <br /> I Z <br /> IF <br /> A yx <br /> C <br /> W' <br /> 6.. L <br /> I 20. Focili Owner or Operator Certification of meipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Mon* Day Year <br /> Y <br /> I <br /> sees DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A(4/97) To: P.O. Box 400, Sacramento, CA 958120400 <br /> r EPA 8700-22 <br />