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:ate of Caiifom':a—En tronmertal Protection Agency-- . _-_ • <br /> Department <br /> Approved OMB No.2050-0039(Expires 9.30.96) See Instructions on back of page 6. Depanent of Toxic S alifornia Control <br /> lease print or type. Form designed for um on eGb(12pitch)typewriter. Sacramento,California <br /> 1. Gemnotor's US EPA ID No. Manifest Document No. 2. Page 1 isinformation req e the shaded areas <br /> F3. r�m,crtor' ARDOUS is not required by Federal law. <br /> NIFEST _ cj - of <br /> Mailing AddressA. n' "9649-905.8O'SHANTER DR, STOCKTON CA 95210 B'State Generotors ID209 473 0909 h 3) ) -t y A' ++ <br /> > 5. Transporter 1 Company Name 6. US EPA ID Number C Stam Tramporter's 1D - <br /> D Trampartrs Phone ,.. .t <br /> 011 Conservation Service Inc. 209x_485 59. E .`. <br /> 7. Transporter 2 Company Nama8. US EPA ID Number - E Stale Tramp. <br /> ID <br /> !r i- <br /> J - F Tcruporteri Phone <br /> 9. Designated FociliName and Sim Address 10. US EPA ID Number G Sfpm Facility's ID a }ta! <br /> OIL CONSNVATION SERVICE INC <br /> 3256 N MARKS AVE, FRESNO CA 93722 fLFoaltlrssph, <br /> c ft. 244x485 545 <br /> 12. Coma'nen13. Total s 14. Unit P ,3,pF;jet^3 <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) Quantity Wf/Vol l Waste Number <br /> Poon RCRA Hazardous Waste Liquid 5f° .,Z`23`• r <br /> []0 r=s <br /> GO l.' ��- G EPA/Odmr-nulj ' s <br /> . � - v<c�rrx, <br /> ' E <br /> 3 N Is. <br /> � E <br /> EPA'Odar':�, N <br /> ER <br /> T <br /> O EPA/Olhet:{m t `' <br /> EPA/Othe!`�„ <br /> ] Addihottaf Des�cn��ptwwfar;�.{amnala Issfed A e��Y't< i s v K Handling Crw'es for Wastes Izsmd Abase 's^",��''G`cvR 3't a <br /> ) � >` §cS N�e x^ � �'-'ys,z- L T:=i.s•`�i��i^J +n,sais'v "'�+e$i<.'�o srv',. - <br /> idT ��eS" ' +"• va daBk.)' d�y" ti�'�'y!�fe,'ds- 'ai�..,Frr a <br /> 15. Special Handling Instructions and Additional Information <br /> Invoice#19887 Emergency Response Contact <br /> 24 Hours <br /> Wear gloves & goggles Don Hartshorn (209)764-6243 <br /> bove by proper shipping swore and are classified, <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described a <br /> packed,marked,and labeled,and are in o11 respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J <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 <br /> 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 <br /> i threat to human health and the environment;OR, R 1 om a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. <br /> Printed/T ged N ma Signature )_�„ /�.;'/.' Momh ! Day Year <br /> y ' r' w) <br /> �(�(�-� /; �\ �;�� /moi!^ y ... ,t moi. % _ / <br /> ' T 17. Transporter 1 Acknowled emenf of Receipt of Materials <br /> jA Printed/Typed Name Signature, j Morrth Day Year) <br /> j 0 18. Transporter 2 Acknowledgement of Receipt of Materials / <br /> R Printed/Typed Name Signature C' March Day Year <br /> f <br /> R <br /> j 19. Discrepancy Indication Space <br /> F <br /> A <br /> 20. Facility Owner or O rator 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 /> JTSC 8022A (1/95) Yellow: GENERATOR RETAINS <br />