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Stele or Gai:'IomiP. --Health end Welfare Agency Department of Health Services <br /> Form Approved OMB No.2060--0039(Expires 9-30-98) -Toxic Substances Control Division <br /> Please rim of type (Form designed for use on elite (laill} awl A Sacramento,California <br /> nerators US EPA ID No, Manifest . Page 1 <br /> UNIFORM HAZARDOUS ' Information in the shaded arses <br /> Document No, <br /> WASTE MANIFEST I n In °f 1 is, not required by Federal law. <br /> 3. Generator's Name and Meiling Address A. Slate Manifest DocumentNumber <br /> Santa Fe Railway Co. <br /> Diamont A E. North St. Stockton, CA 95241 <br /> B. Stets Generator's(D. <br /> 4. Generator's Phone( 213) 267-5454 'N YI 1101 3i 61._-1 nj 1771 ?I `�' 1 � <br /> 0 6.-Transporter 1 Company Name 6. US EPPa�A 10 Number C. State Transporter'a ID ip5 f)rL l g j <br /> v rail - 31Z D. Transporter's Phon`yf�-),r ,9-Jy i <br /> Transporter 2 Co pony Nnmc ✓ 8. US EPA ID Number L, State Transporter'a ID _-J <br /> P <br /> Iransporter's Phone <br /> l <br /> W 9. Designated Facility Name and Site Address 10. US EPA ID Number G.ASlele Fae'In y'a ID <br /> Chemical Waste Management, Inc. II' <br /> 35251 Old Skyline Blvd. H Facility a Phone <br /> Q� Ket Lleman City, CA. 93239 ICIAITIIPP AA 6 1 Y 805 937 a449 <br /> ^(Y- l2-.Qontainers 13. Total 14 I.j <br /> O 11. US DOT Description(including Proper Shipping Name.Hazard Class,and ID Number) Quantity Unn Waste No. <br /> LL Na. Type WIIVol <br /> G e, State <br /> Z G Waste Oil Contaminated Debris 9ol <br /> I N California Regulated Waste Only Q O 1 D T H Y EPM61h}r <br /> 3 E b. slattYe�'�4L <br /> R <br /> 7 EPA/Other i <br /> O <br /> v R o. State <br /> 0 <br /> 09 <br /> 0 r EPAEPA/Other <br /> Wd. State . <br /> Z _ <br /> WEPA/Other <br /> �N J. Additional Descriptions far Materials Listed Above K Ha ndlin Codes for Wastes Listed Above <br /> ° I Bunker Oil Contaminated Debris a b I <br /> LOW <br /> tl. <br /> CDJ <br /> J` <br /> Z <br /> �F 15. Special Handling Instructions and Additional Information <br /> �W Gloves, safety glasses SFO G62195-050 <br /> J <br /> J 16. <br /> V GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping <br /> J name and are classified. packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable <br /> J international and naflonal government regulations. <br /> N 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 1 have selected the practicable method of treatment, storage, or disposal currently available to <br /> O me which minimizes the present and future threat to human health and the environment; OR, if I am a small quantity generator, 1 have made a good <br /> faith raliggl minimize my waste ration and select the best wast n�yaegelF�r(i method that is available to me and that I can afford. <br /> U - <br /> Z rated/Typed Name Signature Month Day Year <br /> w <br /> W -R 17, Transporter,l,Acknowledgesom o[ k` y I of.Materials <br /> .-. ... .... _-._. - ... Y <br /> L87) 1 Printed/Typed Name Slpn urs Month Ds Year. <br /> ' <br /> 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> 19 �iacrapency infill on pace14� 3 -i /�20. Facllay Owner or Operator Certification of toompt of hazardous materials covered by this manifest except as noted in Item1 . <br /> Printa /T d Nary1e Signet e th A(1/a�) INSTRUCTIONS ON THE BACK <br /> 22 Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS Previous editions ere obsolete. <br />