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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-96) ..� Sae Instructions on back of ...49 6. Department of Ta=K Substancm Control <br /> Please prim or typo. Fonn designed for m,an efM(12Rpikh)ypewrit°r. Sacramento,California <br /> 1. Generoters US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br /> UNIFORM FIAZARDOUS1,— es.ui,-d ieMrol low. <br /> WASTE MANIFEST A /1 I — I of <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> 95296153 <br /> 143NIER ROOF 1ILE B. State Gmennolors ID <br /> 5508 S HARLAN RD. FRENCH CAMP, CA 95221 <br /> m re <br /> 4. Geralor's Won; ( rd !;F19-1,67i <br /> . r <br /> 5. Trareperbr 1 Company Name 6. US EPA ID Number C. State Tronsportcr's ID09 <br /> I <br /> ALLIED PETROLEUM C A L 0 0 1 1 2 3 ? q D. rranspomars Phan' <br /> v� 20q-578-8500 <br /> Q <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter s ID <br /> V - F. Transporters Phone <br /> Q <br /> Z 9. Desi rated Facility Naand Site Address 10. US EPA ID Number G. State <br /> facty's ID <br /> ENVTRPOURWEST CAOOf33168723 <br /> � 13331 N HWY 33 H. Facility's phone <br /> j < PATTERSON, CA 95363 C A 0 n 8 3 i 6 6 7 2 6 1300-874-4444 <br /> r] 12. Contained 13. Total 14. Unit <br /> Z 11. US DOT Dneription(iacbding Proper Shipping Name,Hazard Class,and ID Number) No. T ypeOram' Wt/Vol [EPA/OHw <br /> ash Number <br /> i / ffPar 7-C.I�: �y �/.�U i(i-. i–r�-s �� � i /0*/Oaten <br /> E tea co N b.4E <br /> R <br /> A State <br /> gQ T C. <br /> ' O EPA/Other <br /> w R <br /> Z d. �O1Q <br /> W <br /> V EPA/Othw <br /> W <br /> N <br /> J. Additional Descriptions for Materials lbied Above K. Handling Codes for Wash Used Above <br /> Y a. b. <br /> N '( i�to (�,s:.4CI <br /> /U ..F6s c, d. <br /> Q - <br /> Z <br /> Q 15. Special Handling Instructions and Additional Informalion <br /> a USE APPROPRIATE PROTECTIVE GEAR <br /> Z DESIGNATED FACILITY EMERGORY CONTACT���,,,///8'''001-0-74-4444 <br /> x GENERATOR EMERGENCY CONTACT #!n�rf l ('. 73 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment aro fully and accurately described above by proper shipping name and are classified, <br /> V packed,marked,and labeled,and aro in all respects in proper condition for transport by highway according h applicable international and rational government overnmt regulations. <br /> .�.r, If I am a large quantity generator, I certify that I have a program in place te reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> y economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and fours <br /> N threat to human health and the environment; OR,if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> wase management method that is available to me and that I can afford. <br /> O Prinlad/TypPd Name / S gnaNre. Month Day Year <br /> 6 �.Y....: is <br /> W T17. T rte 1 Ackrawb of Recti of Materials <br /> (� A Printed/T me SigboNre i. ,' Month Day Year <br /> ' <br /> N18. T 2 A of Receiptof Materials <br /> T mnth <br /> Prinled/Typed Nae Signauro MoDay year <br /> O n <br /> E <br /> A <br /> ,Wys 19. D'ocreparny kdkatie,Span <br /> V F <br /> A <br /> Z C <br /> I <br /> l <br /> , 20. Fm Owner or Operabr Csrtilkolion of receipt of hazardous materials covered by this manifest eonat as rated in Bern 19. <br /> T Printed/Typed Name Sipahne Month Day Year <br /> y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (9/94) Yellow: GENERATOR RETAINS <br /> EPA 87G 22 <br />