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05/19/05 14:07 FAX 19 002 <br /> - sle of CallFamla—EnviwnlnsnMI ProkJon Agonry Y V iq <br /> m,Apptwtd OMB No.1,Q30-0039�Fspiru 9.30-991 See Instructions on back of& 6. Dsparlmonl oFTeSu6 ioncG Control <br /> rens pnnt ar type. Fampdes4tred for use on eliht(12-pikh) vTlhr. Sacramenm.Gliforo;. <br /> 1. Ganermay,US EPA ID No, Mo0w,Document No. 2. Pogo 1 Information In the shaded ares, <br /> _ UNIFORM HAZARDOUS I is net required by Federal Imr. <br /> WASTE MANIFEST ahLibioioi AililiT41 isi 51 4j 51 1 aF 1 <br /> 3. CLmrvpld Name and Mailing Addnn Jet <br /> TRENT BROWN LEE (Stockton, TjW Center) <br /> . 6364 Lindbergh St., Stockton, Cs 95206 <br /> 4 Genaral.e.More I @)() (#209-982-1622 <br /> S.Tronsparmr I Compa'ey Name 6, US EPA ID Nvmbe4;. t ^r"ra R jc6 <br /> MARCOR Remediation, Inc. MDR 0 1.0 10 10 11 11,18 <br /> 7. Trenspener 2 Company Name 8. US EPA ID Nvmbo, <br /> N <br /> Consolidated Waste ICIKID19181316161815 813 <br /> 9. Detlgnmod PapliryName mid Sib Addrnr 10. US EPA ID Number <br /> .GYOsby 6 Overton u r.rsAfkkP„ <br /> 1630 W. 177th Street <br /> Long Beach, Ce 90813 1CAD JO 12 18 14 10 19 0,J1 9 <br /> 11. US DOT Description Unduding Proper Shipping Name.Ho:ord Claes,and ID Numbarl 12. Gmalnen 13. Total Il. Unit <br /> No: TI Givoolity WWoi t . <br /> RQ haste Fla®able Liquids,-WX7 NOS; <br /> G , DN1993 FG II 0001) , (Tank Rinsate) \` (061 D M 6161 G P P a <br /> N <br /> R <br /> T a ^,. <br /> ' O <br /> R , <br /> d. <br /> s c <br /> i <br /> 3 <br /> 13. Spial Handling Instructions and Addglonol Information <br /> Wear proper protective gear. Emergeuc contact:l). MARCOR 800-888-9501 2) EPA Region IX <br /> 800-535-5053. BAAQIm 939 Ellis St., San JFraucisco, CA 94109 <br /> Job #22-04369-001 Job Site: 6964 Lindbergh St., Stockton, CA 95206 <br /> 16. GENERATOR'S CERTIFICATION: by pro per Alpping name and an daaified,packed, <br /> marked and labeled,and are in all nspe0$m proper confit len for hampon by highway oo.rdInq Io applicable Wornall...I and nalianal government mgulmiou. <br /> IF I am o large quantity genemeur,I codify that I hove o program in place to nduee the volume and lo,idry aF,ua pt panerated b the degree I haw 4aermined k be emnomiadly <br /> Practicable and that I y o$811064 The ymdim6le moth°d aF treatment,norage ar disposal c...rfy avollable Is on,which minimizer the pmwt and Fubm throat a human hoalsh <br /> and the am4mnment;op-it I ora a small q mmiy gansraroq I hwe made a good Faith e8ad b m;n;mlm my wasm generallon and pekd the bat w Io management method that is <br /> a a 61,16 to me and that Iron aFFord, <br /> P'Ned[T ad Name Signmu Month 0 Y.or <br /> 0fLo J�[;W' � � � 0 is <br /> T 17. 7w,porler I Acknmvlad omeN of Recel I aF Maladals <br /> Y Prinkd/Y a e d� I Signo OMenlh 'Day Your <br /> 0 18, Tram tier 2scb,owled ent wi t of Mo/,kriylr ' <br /> ET PrI VA ( Signamrc Morel y Ye r <br /> A <br /> 1 i 6n pace <br /> F <br /> A ' <br /> C <br /> 1 <br /> L <br /> I 20. Fseili Amer oro orator Grlifirolian of toter t of hamrdoW materials rousted rs ma 'Fat 6,M I o,nokd in Ilam 79. - <br /> T hire /Typed Name V Signa Mends Dar 'Ypr <br /> Y �il�r-L � : <br /> DO NOT WRITE LOW. LINE. <br /> SC 8022A It/99I Whlte: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> snO-22 To: P.O. Bat 3000, Sacramento, CA 96812 <br />