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State of California—Environmental Protection Agency Form Approved OMB No.2050-0039(Expires 9-30-991 See (j5#fUCtlO(IS.on back 01' nage 6. Department of Toxic Substances Control Please pnnt,or type. Form designed for use on elite(12-pitch; riter. Sacramento,California generator's US EPA ID No. , Manifest Document N'-- age 1 Information in the shaded areas UNIFORM HAZARDOUS ;_ - ' v `_ Cj Al DI 91 8111 _ •a.- - t is not required.by Federal low. WASTE MANIFEST- '= 31 6 919141 1 of .!1 3, Generator's Name and Mailing AddressI I I A $tate Manifest Document Number 98290287 - CD PO BOX 967 LODI. CA 95241 8 State Generator's ID in � 4. Generator's Phone I ( ( t N 5. Trdhsporter 1 Company Name 6. US EPA ID Number C. State Transporters ID J No 71ANSPORT & _ _ O D Transport r h e CD aN�AL SERVICES JA ID l 1012 8 7 9 9 1_ Nf6Y 372 .2 -- --- 7. Transporter 2 Company Name 8. US EPA ID Number j E. State Transporter's iD � f j QTransporter's Phone 9. Designated Facility Name and Site Address ._._,.Address ---------- 10. US EPA ID Number State Facility's ID tV Z CHEMICAL WASTE MliAtAGlT �l --1�� Of . 35251 `L1It.D $ ,SNE I H. Facility's'Phone o i,KE'r'!`i EMAN CITY t CA 93239 1C JA IT 9 P_0 I6 1 i 7 ' <559) 38l5,-16233_---------'!- rY V 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unil Z a y� g�w�y� Sfi pfd* �y l,.�*r}��; LIQUID i� No. Type Quantity Wt/Vol -j 1. Waste Number NO RCRA HAWDWS YfMiliStir f�.�L first—ate 461, 135 3 G MATER MN`IAKD* ? WITH PAM (WATER E) Ell- }EFA/other oN R IFr State ccoo E - c C, o T State co 0 R LODI MFTA1 I C,1-4 --- -- R FPA,/Asher -- w ---- - d. stat Z w V �FPAiOther w -----T--- ---- ---_----- --- - — --` --`- OJ, Additional Descriptions fur Materials l iN®d::"!o . _ !a noodling W dling£odes for aste Listed Above Let a2 ERC TI Cr 'Prof '.A63Cb9 �r r r' - -- -- --- - - --- r 3 d �. . • C- .zy{rw - 0 15. Special Handling Instructions and Additional Information Z WEAR GWVES & PR,OTEC;'3"IVE CLOTHING SITE: 2.13 ,t.`4� ST. w 24HR EMG. 0 (209) 369--'4683 LODI, U t- ::11 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. V —J' 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 determined to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health and the environment;OR, if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is a available to me and that I can afford. O } Printed/Typed NNom-e� 5ignatur2e Month Day Year w T w 0 R 17. Tans orter 1 cknowled Ma ment of Rec t of terials j wArint /Typ a e ature R A Pi onth Day Year 0 01 19 - 0 1 8. Trans orter 2 Acknow a emenf of Receipt of Materials 0 R Printed/Typed ed Name g Month Day Year T YP Si nature UJ E tv) R Q V 19. Discrepancy Indication Space Z F A C L 1 20. Facili Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. T Print d/ ped Name Signature- / Month Day Year Y d L C 1_0 DO NOT WRITE BELOW THIS E. ' Yellow: TSDF SENDS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 8022A (4/97) (Generators who submit hazardous waste for transport out-of state, EPA 8700-22 produce completed copy of this copy and send to DTSC within 30-days.)