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State c!Celifornie-Health and Welfare Agents Department of Health Services <br /> Form Approved OMB No.2050---0039(Expires 9-3088) , - Toxic Substances Control Division <br /> Please Print Or Me., Form designed for use Or,eGle I' h t ewMer;. Sacramento.California <br /> AL neretor's PAI Nc. Manifest 2. Pee 1 <br /> UNIFORM HAZARD011$ °� C g Information in the shaded arses ' <br /> WASTE MANIFEST d I_ <br /> Document a I <br /> Q. Qi rdl 8 Y I4 1,9 l o I9 14 Id W 1a��r of s is not required by Federal iev, <br /> 3. Generator's Name and Mailing Address A. State,FAamleat Document'T umb4r -� <br /> Beata Xe Railway CO. <br /> 'Diamond 6 S. Korth fit, 8 State Geosratora lD <br /> a asAA9VEr StFQh.( CA ) 95205 (213) '26-745454 i <br /> t .It!4,1 �I 1 <br /> 6. Transporter 1 Company Name 6. - US EPA ID Number C. State Transponer's{.^ ^i <br /> J` <br /> N7. Transporter 2 Company Name 8. US EPA ID Number E. irate Trenaporter's M <br /> D <br /> I F. Transportar'a Phone <br /> ... <br /> 9. Designated Facility Name and Site Address 10. US EPA 0 Number G atela Ycilhy's ID -� <br /> Chemical Waste Management, Inc. I <br /> U <br /> 35251 Old Skyline Blvd. H..Faefity'a Phone <br /> `a Kattlemaa Citp, .rCA 93234I AlTifl <br /> i <br /> � 12. Containers -13. Total r 14. L <br /> O 11. US DOT Description(Including Proper Shipping Name,Hazard Class, and ID Number) Quantity Unit t -Waste No. <br /> w No. I Type WI/ <br /> J <br /> State <br /> G a. Waste Oil Contaminated Debris <br /> .. ... ........ . .. EPA!/ Char <br /> E CaliforiAa Regulated Waste Dal y dnc <br /> H N <br /> 3 E b. <br /> State <br /> N R <br /> W T EPA/Other <br /> d 0 <br /> O1 R c. Stale <br /> a <br /> m - r EPA/Other <br /> W d. state <br /> F <br /> Z <br /> w <br /> w,U EPA/Other <br /> `�rW 'J: Additional Descriptions for Materials Listed Above K Handling Codes for Wastes Listed Above <br /> �o Bunker Oil Contaminated DID a b. <br /> N< <br /> OZ <br /> O h� 15. Special Handling Instructions and Additional Information 1,. I <br /> OOWGloves, aafaty glasses% i <br /> W <br /> l 5Fa— 21 <br /> 6. <br /> Q • � <br /> U GENERATOR'S CERTIFICATION: I herby declare th2T'lhe contents of this consignment are fully and accurately described above byproper shipping <br /> name and are classified, packed, marked, and labeled, and we in all respects in proper condition for transport by highway according to applicable <br /> International and national government regulations. <br /> rwq If I am a large quantity generator, I certify thAH"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 /> 0 me which minimizes the present and future threat to human health and the environment; OR. it I am a small quantity generator, I.have made a good <br /> Q� faith effort to minimize my waste generation aknd select the best waste management method that is available to me and that I can afford. <br /> 99 11 <br /> t`0y� Printed/Typed Ne a ._ Signaturee -Month Day 1Ygar <br /> W <br /> g T 17, Transporter 1 Acknowledgement of Recnt t of Materiels <br /> - ." ipnetur - "Monf Dey '.Ymr <br /> = A PrintediTTyg/,Pd Name F (41/w Incojj <br /> LL N �./V i/ 1 <br /> S <br /> O lia <br /> 0 18, Transporter 2 Acknowledg e in ant a1-R Aidetptof Me feria is _ <br /> Ww R Printed/T ed Name <br /> T YP `" SignaNev Month DAY Year <br /> -;p E <br /> Z x,19. liecrepency Indication Space (� , <br /> t <br /> 4 e <br /> j. . 20. Facility Avner or Operator.CartlBcation of7ipf�t of hazardous materials co red by this manifest except as noted In hem 19. - .. <br /> T Prmtaq/Typed Name Sign ure Month Day Year <br /> r i D <br /> DHS 8022 A 1/87) - '� <br /> EPA 8700-22 Yellow: F SENDS THIS P„Qf"ATOR WITHIN 30 D S INSTRUCTIONS ON THE BACK <br /> (Rev.8-86) Previous editions are obeolele. , <br />