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S?mi of Califomio---Emirmmenfol Protection A➢emy4 I.. <br />Form Approved OMB No. 2050-004 lExpires 9-30-94) <br />Plmse Print or typo. Fomr ckmgm d for use an elite (129Mh) ypewrirer <br />See Instructions on back of pa4e--'6. 6openmont of Tosfc Substances Central <br />Sanmmen e, Califomiav-'. -:{ <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC. 8022A (9/93) <br />EPA 8700-22 <br />Yellow: GENERATOR RETAINS <br />1. Generators US EPA ID No. Manifest Document <br />No. 2. Page 1 Information in the shaded areas <br />UNIFORM HAZARDOUS <br />is nal required by Federal law,- <br />_ WASTE MANIFEST f'] ;_ kil 01 1101511:1 1 3 b )I 0 <br />P 1 <br />8 a I of 1 - - <br />W. <br />3. Generators Nand Mailing Add. HAYLK)NU rt MCli <br />245 W. CHARTER WAY <br />>'TOCKTON, CA 95256 <br />4. Gerserators Pham I; )-• ;:•_"(. > 466-8604 - <br />"`�•' <br />-' e, -'- <br />S. Transporter 1 Company Name 6. US EPA ID Number- - - <br />SFK>F? HAZARDS SOLUI IONS ICIA101010101614161419 <br />.T�"!L(t <br />7. Transporter 2 Company Name 8. US EPA ID Number"7- <br />G sSfateFo01 - i�lD' <br />� <br />9: Desinoted Fadl' Nome and Site Address 10. US EPA ID Number <br />ST.AI�WIDE ZNVIROI#&N7'AL <br />f <br />12618 MAIN STREET <br />LOS ANGELES. CA 80061 ICJAIDIOIOIOIOIOIB121E <br />13. Total 14. Unttr <br />Tyce Qr VM/Vd. <br />11. US DOT Description (including Proper Shipping Name, Hazord Class, and ID Number) <br />12. <br />Containers <br />No. <br />NO&I RCRA HAZARDOUS WASTE, LIQUID <br />G <br />(OIL & WATER) <br />0 0 <br />i <br />D f+l <br />( <br />P' <br />E <br />N <br />E <br />- b. <br />NON RCRA HAZARDOUS"WASTE, SOLID <br />.. <br />R <br />(OIL & DIRT) <br />0 0 <br />1 <br />D 1A <br />Z <br />P. <br />A <br />4j if Ispo <br />0 <br />NON RCRA HAZARDOUS WASTE, LIQUID <br />9 <br />(OIL, WATER. SLU)GE) <br />0 0 <br />1 <br />0 11 <br />9f / O <br />P <br />.:. d.. <br />X, WASTE SULFUR, 4':1., UN1350, III <br />01011 <br />D 1 F <br />Y oy 0 <br />P' <br />*. `• 5 <br />c t <br />1S'Spedal Handling Instructions and Additional Informafi024 HOUR ELSERGENCY RESPONSE NUMBER 1 ( 800) 393-4357 : <br />1tA. PROFILE #26603-A 11C. PROFILE #26608-A <br />11B. PROFILE #26605-A i1D. PROFILE #26604-C <br />`r <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contems of this consignment arc fully and accurately described above by proper shipping name and are do.iiied, -: <br />packed, marked, and labeled, and are in all respects in proper condition for transport by highway according <br />to applicable international and nalional government regulotima. <br />If 1 am a large quamiy generator, I malty that I have a program in place to reduce the volume and <br />toxicity of waste generated to the degree I have delermksed to be <br />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the pre art.and future . <br />threat to human health and the environment, OR, if I am a small ua e o d of generation and ule0 the best - - <br />-9MALlave(7� eW0,*f4M ftgj tbeyLMAI s1e ° - <br />weste management method that is available to me and that I can offorddR <br />Pr; yped Nam Signals,Month <br />- <br />Day Year <br />V 'A Mop <br />ILi�VI <br />© j*30 <br />9 . <br />t <br />17. Transport r 1 A&nowlehilerment of Receipt of Materials <br />A <br />P mismoI vd Nome <br />Signature <br />March Day Year - <br />0 <br />18. Tmns orter 2 AcknowmIgnmene of Receipt of Material, <br />7 <br />Printed/Typed Name <br />Signature <br />Month Day Ysor <br />E <br />R <br />19. Discrepancy Indication Sporn <br />A <br />C <br />I <br />L <br />I <br />20. Faril' Owner or rotor Certification of receipt of hazardous materials covered this manifert mo, t <br />as noted in Mem 19. <br />T <br />Prinhd/Typed Nome Signature <br />Month .- Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC. 8022A (9/93) <br />EPA 8700-22 <br />Yellow: GENERATOR RETAINS <br />