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State of California-Environmental Protection Agency � �C''t-\,� <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of a 6. Department of Toxic Substances Control <br /> Pleose print or type. Form designed for use on elite f 12-pikh) , itec Sacramento,California <br /> UNIFORM HAZARDOUS Generate/s US EPA ID No. Manifest Document No. 2. Page 1 I Information in the shaded areas <br /> WASTE MANIFEST is not required by Federal law. <br /> 1 of <br /> 3. Generator's Name and Mailing Address A. Slate Manifest Document Number <br /> 1 X-V FREIGHT ROADWAY <br /> h 3233 LOOMIS RD. , STOCKT'ON, (-.A 95205 B. State Generator',ID <br /> 4. Generator's Phone 12091-.466-2902 <br /> h5. Transporter 1 Company Name 6. US EPA ID Number C. Slate Transporter's ID[Reserved.] <br /> o CONSOLIIIATED WASTE IND. D. Transporter's Phone <br /> au 7. Transporter 2 Company Name B. US EPA ID Number E. Slate Transparter's ID[Reserved.] <br /> P— <br /> < F. Transpormr's Phone <br /> U 9. Desi nated Facility Name and Site Address 10. US EPA ID Number G. Slate Facility's ID <br /> c-Id CROS I�3Y. AND OVERTON <br /> a~-io 1630 WEST 17TH STREET H. Facility',Phone <br /> LL LONG BEACH, CA 90813 J 562-432-5445 <br /> �Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number 12. Container 13. Total 74. Uoil <br /> ,�JU P ( 8 P PP' 8 I No. Type Quantity Wt/Vol I. Waste Number <br /> Z NON RCRA HA7ARDWS WASTE. SOLID State ;tiw f <br /> (LKIff GLUE y ABSORBENT) <br /> c EPA/Other <br /> 3 0112-1010� , LIZA <br /> o N b. State <br /> i� <br /> a°Do E <br /> NR EPA/Other <br /> v A <br /> OT C. Slate <br /> act O <br /> R EPA/Other <br /> K <br /> � d. State <br /> Z <br /> W <br /> U EPA/Other <br /> u <br /> � <br /> J. Additional Descriptions for Materials Listed Above K Handling Codas for Wastes Listed Above <br /> Zi "!A.1 `t t 5 5G V-, 0'r S 'P. "'., ._ ".777F.L:.I;RUPol(ovr` aticx) 6. <br /> h <br /> oc <br /> oc c d. <br /> Q <br /> Z 15, Special Handling Instructions and Additional Information <br /> 0 <br /> a uI-Ak APPROPRIATE' SAFF.n' EQUIPMENT. IL. , <br /> Z 24HR EMEIrYENCY CONTACT:LEF. BARFIELD/510.638. 1684 G <br /> SITE ADDRESS: SAME AS GENERATOR D-- <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignmentare fully and accurately described above by proper shipping name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> 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 <br /> d practicable and that have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and Future threat to human heaBh <br /> 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 <br /> O <br /> available to me and that I can afford. — -- <br /> } Prd'slled/Typed Name L Signature �J.. // Month Day Year <br /> Zi r} �f? l0 C.(,+r-- ✓ ce .L. .r L- .�� C_. _<' 2 <br /> W T 17. Transporter 1 Acknowled ement of Receipt of Materials <br /> R <br /> aj A P{jpted/Typed Na a\�^q /](^ / '� Signature / Month Day Year-.,,..- <br /> wv ..,, GCI! -1C L-./V(d '/�1-; ....1 - <br /> u- a 18. Tronstsorer 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Name SignatureMonth Day Year <br /> w E <br /> N g <br /> U19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 877000— <br /> DISC 0 —22 Il/991 To: P.O. Box 400, Sacramento, CA 95812-0400 <br />