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Stale of ifomia—Environmental Protection Agenry 185-01 <br /> Form ved OMB No 2050-0039'(Expirm 9-30-99) See Instructions on back 6. Department of Toxic Substances Control <br /> Plea pint or type, Form devgned prose on elite(12-pile awrifor. Sacramento,California <br /> UNIFORM HAZARDOUS 'Y'B"eialor's US EPA ID No. - Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST C Q Q 1 04 2 B of 1 is not required by Federal law. <br /> 3. Generator's Nanta and Mailing Address SIERRA CHEMICAL CO A. Stale Manifest Document Number 21741774 se 7 41 7 y 4 <br /> �p 10 INDUSTRIAL WAY LO- IL 1) 1/ <br /> O I�, TN ROGER R. state Generator's ID <br /> 51OCKTON CA 9-4204 <br /> A. Generator's Phone(2091 983-8898 <br /> sN 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID(Reserved.] <br /> 6 SAFETY—KLEEN SYSTEMS, INC R 7 1 D. Transporter's Phone <br /> Oa00 669-5740 <br /> _00 7. Transporter 2 Company Name 8. US EPA ID Number 's E. State Transporter's ID[Reserved.] <br /> �J <br /> F. Transporter's Phone <br /> 9. Desi noted Facility Name and site Address 10. Us EPA ID Number G.State Facili 's ID <br /> SAFETY—KLEEN SYSTEMS, INC C T7 0 i <br /> 2 5050 SALIDA BLVD <br /> � W SALIDA, CA 95368 C T O 2 968 H. Facility's Phone <br /> Jr" u- 209 545-1011 <br /> 11. US DOT Description Including Proper Shipping Nome,Hazard Class,and ID Number) 12. Containers 13. Tolyl Unit <br /> N N. T Wt e Quantity Wt/Vol I. Wastt <br /> e Number <br /> Z a. Stale <br /> = WASTE COMBUSTIBLE LIQUID, N. O. S. DM 6 741 <br /> 3 G (PETROLEUM NAPHTHA) N61993 PGIII RQ EPA/other <br /> (DOOI)ERGk128 (6. 7k/Q ) (D018, D039. A040) 0011 1 610101 0001 <br /> O <br /> N b. State <br /> co E <br /> -' R EPA/Other <br /> v A <br /> 6 T a <br /> style <br /> m O <br /> _ R EPA/Other <br /> cc <br /> d. - State <br /> Z, <br /> U EPA/Other <br /> W <br /> h <br /> J. Additional Descriptions For Materials Listed Above - K. Handling Cedes for WostesLisled Above <br /> Z Ill DOSS D039 (A) D040 °'. 14 b. <br /> W <br /> d. <br /> 0 15. Seecial Handling Instructions and Additional Information 0231 1O236-957EF—U0-9' T3—,!6E16V <br /> EMERGENCY RESPN800-468-1760 24HR <br /> Z <br /> F 1 A B01 B C D <br /> 16. GENERATOR's CERTIFICATION: I hereby declare that the conten6 of this consignment are Fully and accurate) described above by proper shipping name and are classified,packed, <br /> Vmarked,and 66.6d,and ore in all respects in proper condition for transport by highway according b applicable international and national government regulations. <br /> J IF 1 am a large gvantiy generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically, <br /> d practicable and that U.selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have made a good Faille effort to minimize my waste generation and select the best waste management method that is <br /> O <br /> available to me and that I can afford: <br /> } Print Type Name I Signature mo all Day Year <br /> Z p 7 gs O <br /> W T 1 ran 11200ir I Acknowled erne of Receipt of Materials <br /> O R <br /> W t Pr' d/r Ped Name I Signabre/, Month Day Year <br /> X <br /> W 0 18. Transporter 2 Acknowled emenl of Recei t of Materials <br /> O T Printed/Typed Name Signature Month Day Year <br /> W ER <br /> U <br /> U <br /> - 19. Discrepancy Indication Space <br /> Z F <br /> — p <br /> C <br /> 20- FaciliteOwner or Operator Certification of recap t of hazardous materials covered Wthis manifest except as noted in Item 19. <br /> T I Printed/Ty ed Nome Sign Wre I JAonth Day Year <br /> Y 212 IS I n] <br /> DO'NOT WRITE BELOW THIS LINE. <br /> -"" Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (1/99) e.a (Generators who submit hazardous waste for transport out-of-stare, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br /> i�YViTw. S r <br />