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' Form Approved OMB No. 2050039(Expires 9-30-88) Toxic Substances Control Diviviou <br /> Please print or type. (Form designed for use on elite(12-pitch typewriter). Sacramento. Celnomic <br /> I UNIFORM HAZARDOUS 1 10stator's US EPA ID No. Document <br /> Page 1 I Information in the shaded areas <br /> WASTE MANIFEST I Document No. of q <br /> III e I T O .Q 1 L I S C is not required by Federal law. <br /> 3 Generator's Name and Mailing Address I A State Manifest Document Number <br /> Santa Fe Railway Co. -r T 3159 _ I <br /> I ,ftamond & E. Worth Street, Stockton, Ca. 95305 a State GeneratofsID <br /> +'14. Generator's Phone( 213) 267-5454 - 11 Y 61 �I 3 P 1 '0I 7 31811 <br /> ' <br /> h 5. Tjenap r 1 Co�npeny fla�e B^ h US FPA ID Number n Q State treneporter'a 10 C -2 <br /> '0 /+(. ✓y /JS, <br /> IS Y /a $I / I2V D. Tranaporter'sPhone / q. 7015 <br /> n <br /> N <br /> 7. Transporter 2 Company Name 8, US EPA ID Number E. State Transposaw s ID <br /> m <br /> c <br /> I I I I F. Raneperte(s Phone <br /> m 9. Designated Facility Name and Site Address 10. US EPA ID Number ate Facility's ID <br /> J Chemical Waste Management, Inc. > t/ <br /> U <br /> 35251 Old Skyline Blvd. H. Facility's Phone <br /> <_ Rettlemn City, Ca. 43239 C P P P j 6 416 1 1 c (805) 937-8449 <br /> = 12. Containers 13, Total 14. I. <br /> 2 <br /> Ii, US DOT Description(Including Proper Shipping Name,Hazard Class, and ID Number) Quantity Unit Waste No. <br /> LL No. J Type WI!Vo <br /> Stare <br /> a Waste Oil Contaminated Debris <br /> E California Regulated Waste Only0 0 0 i D Y" EPAro tr <br /> N <br /> 3 E b. State ' <br /> R <br /> om A <br /> EPA rOlher <br /> op T <br /> O j< R o. Stale <br /> ap EPA/Other - <br /> a d. State <br /> N <br /> Z 'EPA/Other <br /> U <br />"�rLLjl J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br />�o Bunker Oil Contaminated Debris. _ ' - a. © <br /> fd <br /> Z <br /> w <br /> k^�aJ <br /> y�7 <br /> 15. Special Haddling Instructions and Additional information <br /> 00Z <br /> = Cloves, Safety Glasses SFO G62195-050 <br /> J <br /> 'r 18 <br /> U GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping <br /> name and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable <br /> international and national government regulations. <br /> m 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 <br /> 2 determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to <br /> U me which minimizes the present and future threat to human health and the environment; OR, it I am a small quantity generator, 1 have made a good <br /> faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. <br /> U <br /> Z PrinttpaMTyped Name Signator Month Day Year <br /> � � �'✓i .tJ L' �17 �� 'L/ fr <br /> w T <br /> w <br /> R 17. Transporter 1 Acknowledgement of Receipt of Materiels <br /> = A Printed/Typed Name Signature A// Month Day Year <br /> a N 1i <br /> S .I�Tt,r�cA.c v s <br /> LL <br /> O p 18. Transporter 2 Acknowledgement of Receipt of Metenels <br /> rW T Printed/Typed Name Signature Month Day Year <br /> U E <br /> z <br /> — 19. iscrepari Indication Space <br /> A <br /> C <br /> I <br /> L <br /> I 20. Facility Owner or Opera rtaication of receipt of hazardous materials covered by IDi ifeet except as noted in hem 19. <br /> T Printed/Typed Name - Signature -Month pgy Y r <br /> OHS 8071 A(1 r87) 7 L <br /> INSTRUCTIONS ON THE BACK <br /> EPA 8709--22 Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> -(Rev.9-88) Previous editions are obsolete. <br />