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M <br />4 <br />L <br />k <br />i <br />ap'_1 <br />State of CalikmOMB No, <br />39lExion Apeney <br />Form Aprint er OMB Form dearr039 (rasion 9.30.99( See Instructions on back of a 6. <br />Plwae printer type Fano drlgnod for use on diro (11-piKM1J yps'4i nlei 7 $— O 1 <br />Department of Tmic Substencer Control <br />Sacramento, Colilomia <br />DO NOT WRITE SELOWTHIS LINE. <br />PR <br />,QLr�# :,Ast) 02000258 36 <br />DTSf 1'll#(I/a9 0040041797 White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Boa 3000, Socramento, CA 95812 <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. - Manilesl Document No.: 2. Page 1 <br />Information in the shaded ore.. <br />WASTE MANIFEST 1 <br />I <br />lea requrequiredrequiredby Federal low. <br />of <br />3. GwoMfoe',NomeandMaitlngAddren EAGLE BAG CORP. <br />A. SbroMwOotDocummtNumber <br />700 A INDEPENDENT RD. <br />2.2962561 <br />I <br />OAKLAND CA 94621 - <br />R. Stan GeneraNrs ID <br />) <br />d. Gweralor. Pham (5101 639-7191 <br />V <br />5. T.,,porbr I Company Nome 6. US EPA ID Number <br />C. SbN T...f aster's IDR served.( <br />a <br />D. Trwsparters Phone <br />SAFETY-KLEEN SYSTEMS, INC R?OP91?1P9 <br />1. Trampan 2C y Name 8. US EPA ID Number <br />E. Stats Trans,rler's ID fRerane .1 <br />Transporter's Pham. <br />9. Dialrefind Facility Name and Site Address 10. US EPA ID Number <br />G. Sbro Facility's ID <br />000658 <br />JKTDP13p4Of <br />SAFETY-KLEEN SYSTEMS, INC.H. <br />Fadhy'rPhom <br />3700 LAGRANGE ROAD D 5 4 1 <br />j <br />11. US DOT Descriplion (including Proper Shiwing Nome, Hazard Class, and ID, <br />12. Conta-iners <br />13. Tool <br />IdUnit <br />TypesVol <br />o- <br />7 <br />L Wash Number <br />Slab <br />RQ WASTE FLAMMABLE LIQUIDS, TOXIC, <br />341 <br />G <br />N.0 S. TETRACHLOROETHYLENE, PETRF.RrOLEUM <br />D <br />P <br />EPA/Other <br />E <br />NA <br />i N <br />b. <br />srote <br />i E <br />EPA/Orher <br />t It <br />A <br />T <br />State <br />i O <br />EPA/OIMr <br />R <br />i <br />d. <br />State <br />I <br />t <br />EPA/dher <br />f Additional Descdp6ws far Me lIawl, Listed Above - <br />K. H dl' g r for Wastes killed Al.. <br />IA) :D018 D039 741 <br />b. .. <br />13 Special Hwdlinsbu-twclions and Additional Information _ <br />MFST R/T#104422557 00028872-95 <br />EMERGENCY RESP 800-468-1760(24 HR). IF UNDELIVERABLE RETURN --TO GENERATOR. <br />SK CORP' AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY. <br />c <br />-1& GENERATOR'S CERTRIGTION: t hereby dedwetha'rhe contenha is cwsi9 miler are an aauralely described obovsb p' ng namearid orodassi8ad, packd, <br />marked, and labeled, and we in o11 rea'M. in proper candirian for hamport by highway acwrdin re a plicabla international .,d Deet <br />_ g P government regdofiao. <br />IF 1 ora a large quamiq generator, I certify that I Hors o proram in place M reduce the volume and tonicity of ..,is generated b the degrw 1 haw determined b hs.eepnomicolly <br />predicable and that 1 h ve s.1seed the procticabls method of Informers, storage, ar dispaa I curmthj a loble to me minimizes the Futuro Ihrwl Feel <br />which present and to7lman - <br />and the emimnmeet; OR, if I am mall quantity gen rater, I hale made o good raid, abort te mmimix my waste gwerafo d selrr the best wmle management geth'odthat.ii'- <br />owilable to me and that I wn alkyd. <br />Printed/Typed'Name KA/ A , / ' /,s _ 1 Signature Month - Day .{Ywr <br />v <br />Wd'f/Mo],k1ten, <br />1 <br />17. Transporter l Adeowled emwtemse/�oTt offRRessi is <br />MPrinted/T <br />Drab <br />Sign a <br />Mwrh -Ywr <br />Ea <br />R <br />18. f7inspor4w 2 Acknowledge..I of 45.iPI.fAMarriah <br />1 <br />E <br />Printed/TY igwture _ <br />Mon/Gay Ywr <br />R <br />19. Dtsc,v m,Irdicalion Spon <br />F <br />A <br />C <br />1 <br />L <br />f <br />10. Facile leer Ooraror Nlicatian t h ardour materiels <br />covered 6 This ani O eace geed in Itest 19. <br />i <br />Prinrod/T Nome <br />Signature <br />th <br />Y <br />DO NOT WRITE SELOWTHIS LINE. <br />PR <br />,QLr�# :,Ast) 02000258 36 <br />DTSf 1'll#(I/a9 0040041797 White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Boa 3000, Socramento, CA 95812 <br />