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StateofCalifomis—Health and Welfare'Agency <br /> For,r Approved OMB No.20.50--0039(Expires 9-30-Bs) Department at Health Services <br /> Pies Be Dr,W. ort e. (Form desnetl for use on elite I t, 'Ch f ewrlfer,. Toxic Substances Control Division <br /> I' Sacrari(;,!,to <br /> UNIFORM HAZARDOUS Orator's US EPA 10 No. Manifest 2, Page 1 -- <br /> WASTE MANIFEST C A n Document No. Information In the shaded areas <br /> N- 4 0 0 0 of <br /> 0 9 T is not ro.quired by Faderei law <br /> 3, Generator'a Name and Mailing Address <br /> eu T,ta Fe Railway CO, A. State Manifest Docurlont Number <br /> 1) amond and E. Worth St. 1 <br /> Stockton} Ca. 95206 <br /> 9. State GOneralor'6 ID "---I <br /> a. aOgke!or'a Phone( 213) 267-54514 _ .. - <br /> ' C lS !y h I <br /> 5. Transporter 1 Company Name 6, US EPA ID Number C. Stets Irensportar'e ID <br /> D. TranspOrter's Phone <br /> 7. Nanaporter 2 COmpan Name 0. US EPA ID.Number,. <br /> QI;A PI <br /> `Y ci' ' r''' 4;?.V F. Transporter'a Phone <br /> 9. Designated Facility Nema and Site Address'', 10. US EPA 10 Number <br /> ChelEicai 'riset� Mara <br /> sage 1pic. Mata Feaaava 0 <br /> 35251 Old Skyline Rd. -I <br /> `ket1:16man Civ,% Ca. 932134 acibry's Phone <br /> PTO 0 0 6 4 6 111 7 a. <br /> I I I $209 j 3£iF.-9'.1. <br /> 11. US DOT Description mol in Proper Shipping 12. Conlan 13. Tote! 14. 1. <br /> D op Aping Nema,tWzertl Class,and 1D IWmber) I Quantity Unit Waste No. <br /> a. No. I Type t/vo i <br /> Waste Gil Contaminated Dill 7 CAliforiTia _ <br /> iii C-Aly <br /> R <br /> A <br /> 0 I i EPAr011nO, - <br /> e+ato —1 <br /> tl EPA/Other <br /> t9tate <br /> 'EPA/Other <br /> J. Additional Descriptions br Matedele Llsletl Above. K. Handling Codes for Wastes Listed Above <br /> Bunker Oil contaminated Debris U,+ 'z b <br /> d <br /> 15. SPeCIaL.Handling Instructions and Additional Information <br /> Gloves, Safety glasses SrO G 62195-050 <br /> 16. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by propershipping <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 /> 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 /> determined to be economically practicable and that I have Selected the practicable method of treatment, storage, or disposal currently available to <br /> me which minimizes toe presentraPd lmure threat try human heanh and the environment;QR, if I am a small quactny generator. I have made a gold <br /> faith effort to minimize my waste generation and select the best waste management me <br /> thotl that is available to me and that 1 can aHOitl. <br /> k <br /> Printed/Typ me Sig <br /> ✓ i S - lill Day Year <br /> T 17. Trendporter 1 Acknowledgement of genear,of Mate rise, V' il. <br /> R <br /> A Print/e,df/Jjyped Name �a n fur <br /> S /-/ !� f �' Al ��) S"/I _ r q / ,,..- Month Day Year <br /> p / \ A `S Jam.,Id <br /> O 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed yped Neme Signature <br /> E Month Day Year <br /> _ 19. Discrepancy Indication Space <br /> A - <br /> 1 <br /> L <br /> 1' 20. Facility Owner or OperatortQ se ification of receipt Of hazarcous materials covered by thio me 'eat excep ea nota(in Item t9. <br /> T Printed/Typed Name <br /> Y - Signature 40 df Month Day ,c7 <br /> DHS 8022 A(1/87) <br /> EPA 8700--22 Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS INSTRUCTIONS ON THE BACK <br /> (Rev.9 86) Previous editions are obsolete. <br /> IN CASE OF AN EMERGENCY OR SPILL. G\LL THE NATIONAL RESPONSE CENTER 1-800-424-8802; WITHIN CALIFORNIA CALL 1-800-852-7550 <br />