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State Of California—}lealth and Waiters Allen Cy <br /> Fgrm Approved OM13 No 2050-0039(Expires 9.30-86) Depnrtmnm of Health Services <br /> rill so riN or t e. " Toxi<.Substuncos Control Divlsmn <br /> (Forte dos, ned in,use on elite( -h I swore . 411. <br /> Sa cramsnlo,CellforNe <br /> UNIFORM HAZARDOUS -moratoria US EPA ID No, Manifest 2 Page 1 <br /> POIIASTE MANIFEST Document No Informenon in the shaded areas <br /> of is not required by Federal law. <br /> a 3. Geneve tar's Neme and Meiling Address - <br /> A. Sial Manifest Document Numbs. <br /> Santa Fe 1dailli Cc. +r)A <br /> IriOnd b. r'Ctrt11 S t,L6 $f CIC .f_3n, !t i2 'S R. State Generator's ID <br /> 4. Generator's Phone <br /> 5. Transporter 1 company lvame r` <br /> E. US EVA ID Number C- Stefa irnnsporter's IL <br /> �l D. 6' ' <br /> Transporters Phon „'T-- <br /> y. ransP rter "ComPenY erne <br /> .✓��^--�•—••+-,+.>.-.31. US EPA ID Wlmber E. SMIa Treneporter's D <br /> F. Tmosporter's none <br /> B. Designated Facility Name end Site Address 10US EPA ID Number G Star sci4ty'a if) <br /> 0 <br /> Checiical Wastz. Yanae:©ger, znc. f f jl? ,1� i <br /> 35251 Old Skyline Road H. FacilnY's Phone <br /> Kettleaean Cit Ca. 932;SQ I� I.; [ 4 6 1 1 7 805" <br /> 1 L'U6 DOT Description(Including Proper Shipping Name,/Wzard Claes.and b Number) 12. Containers 13. Total 1 14. ). <br /> OuantltY Vnn -Waste No <br /> No. I Typo i/Vo - <br /> IS, e West* Oil COntaMincttd DvDris &ate <br /> Grit€apFzia a.2ruitered Vs®r; <br /> A <br /> - EPEP AI 'Obu,' s <br /> R <br /> 1 State "1 <br /> I <br /> 'EPA/Other <br /> tl <br /> State <br /> EPA/Other <br /> J. Additional Descriptions for Materials Listed Above <br /> K. Handling Codes lir Wastes listed Above <br /> a. b <br /> _Bunker 411 Ebrztan)i)zated Gebri <br /> 15. Special Handling Instructions and Additional Information <br /> Gloves, Safety Glasses SFO 1162195-050 <br /> 16, <br /> 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 ell respects in proper condition for transport by highway according to <br /> international and national government regulations. applicable <br /> If I em in large be <br /> con generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have <br /> determined to ba economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to <br /> me which minimizes the present and future threat to human health and the environment; OR, If 1 am a small quantity generator, I have made a flood <br /> faith efaort to minimize my wastelgenerelion and select the best waste management method that is available tome and that 1 can afford. <br /> Printed/Typatl Neme Signature <br /> " .!\ rr r MONK Day Year <br /> 1l. Transporter 1 Acknowledgement of Recglpt of Materials t r3 <br /> R <br /> H Printed/Typed Name Signetur� <br /> S ` � fn, Mouth Day Year <br /> PO 18. rens porter 2 Acknowiedgemenl of Receipt of Materials - <br /> RPrimed/Typed Name <br /> E _ Signature Month <br /> Day Year <br /> 18. Discrepancy Indication Spec. <br /> C <br /> L. <br /> I 20. Facility Ownereretor'OertlfJoe tion of receipt of hererdous meteri u,,covered by Ihie manficar except as noted in Item 19. } <br /> YPrinted/Typed N in Signature <br /> Month Day y r <br /> 000' 01 <br /> DHS 8022 A(1/87) <br /> EPA 6700-22 Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS INSTRUCTIONS ON THE BACK <br /> (Rev-9-86) Previous editions are obsolete. <br /> 1 <br /> IN CASE OF AN EMERGENCY OR SPILL, CALL THE NATIONAL RESPONSE CENTER 1-800-424-8802; WITHIN CALIFORNIA CALL 1-800-852-7550 <br /> i <br /> - i <br />