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State of Colilornio—Environmental Protection Agency <br />Form Appi wed OMB No. 2050-0039 (Expirm 9-30-99) SBC Instructions on back ^f page b.. Deportment of Toxic SubstancesControl <br />Pleose print or type. Form designed forum on Offs, (12 -pi yewrlfur. Sacramento, California <br />0 <br />h <br />n <br />h <br />O <br />O <br />m <br />J <br />7)Q <br />/ <br />DISC 8022A (4/97) <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS LINE. <br />Green: TRANSPORTER RETAINS <br />Generator's US EPA ID No. Manifest Du ANO. <br />2. Page 1 <br />nfo ma8on in he shaded am, <br />UN'rFORM HAZARDOUS <br />is not required by Federal low. <br />WASTE MANIFEST A': CI 3 5' e' 1 1 S4 7 <br />ap t <br />3. Composts,, Name and Mailing Address <br />A. St.4 Manifest Document Numb;r ^ ys ^ ^ <br />AVO8 <br />_IJN WEST L! QLJLiR9 <br />L V4 <br />a49 W. k:ETT'LEMAN LANLE. LODI, CA 5524a <br />B- State Generabr's ID <br />4. Generator's Phone ( fay 13:33— 1 V21] <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C State Transporter's ID <br />NUR +_AL OIL C AD 9 SZ 4 17 O 5 <br />D. Transporter's Phone ,. ��) j � fyl]7 "'�i �s y ^• <br />7. Tronspors,r 2 Company Name S. US EPA ID Number <br />E. State Transporter's ID <br />F. Transporters Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G, Stone Facility's ID <br />BA-Y'n1vi:E 0 1 L II. 1140. <br />! 1!? Ei,11_ INAL STF'EET <br />H. Facility,Phone <br />11. US DCT Description din Froper Shipping Name, Hazard Class, and ID Number <br />(11iO 8 p PP 8 I <br />12. °"'ai"ers <br />13: total <br />Quantity <br />' I f Unr <br />Wt/Vol <br />1, Waste Number <br />No. <br />Tye <br />Ip <br />r:UN—NCF'r; HFaZr,kllUU� WA -.TE LIQUID <br />111 3 <br />G <br />S WATER• i <br />l i Q i <br />T T <br />13 <br />EPA/Other <br />E <br />N <br />b. <br />stale <br />E <br />R <br />EPA/Other <br />Tc <br />__. <br />state <br />EPA/Other <br />R <br />d. <br />State <br />EPA/Other <br />J. A ibona sc ons For Materials Listad Above '• ",- _- ^^: <br />K Handling Codes for Wastes <br />Listed Above <br />b. <br />. ... <br />1 L.. <br />t <br />15. Special Handling Instructions and Additional Information <br />,FFF'OF'RIATE PROTECTIVE 1=:LO'THIN13 <br />"EMEF:GENCY CGNTACT: (ZE)3i541—,3145't <br />SEE i. R. Li. 171 <br />16. GENERATOR'S CERTIFICATION: I herebydeclore that the contents of this consignmentare full] and occuris described above by proper shipping name and are classified, packed, <br />marked, and labeled, circ are in all respects in proper condition for transport y highway according "app icable international and national govamment regulations. <br />4 <br />IF 1 am a large uanti gmm in place to reduce the volume and moiciy, of waste generated to Ilse degree I have determined to be emnomicai1 <br />g q y generator, certify that 1 have a pro <br />I hove <br />practicable and that selected the ppracticable method of treatment, storage, or disposal currently available to me vhicb ei_ raae, th, present and future threat to humor. hemi... <br />and the arA,.v n.nr; OR, if i can a ..if gaantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management metFwd that is <br />available to me and that 1 can afford. <br />Printed//Typ Name <br />Signohre "" Manlh Day Year <br />T <br />17. Trans rter I Acknow, ement of Rec t of Materials <br />A <br />Prins,d/Typed Name <br />Signature <br />Month Day Year <br />R <br />JfjC FUETT <br />p <br />i <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials ' <br />RPrinted/T <br />T <br />YPed Nome <br />Signature <br />Month Day Year <br />RE <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />20. Facili Owner or O eror Certification of receipt of hazardous materials <br />covered this manifest eom t as noted in Issues 19. <br />T <br />Printed/Typed Nama/• <br />Signatore ( <br />Month Day year <br />/ry <br />L <br />/ <br />DISC 8022A (4/97) <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS LINE. <br />Green: TRANSPORTER RETAINS <br />