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Sla a of Cali(ondo—Environmental Protection Agency <br />swat Approved OMB No. 2050-0039 (Expires 9-30.99) See Instructions on back rr --qe 6• Department of Toxic Substances Control <br />°lease prim or type. Form designed (or me on diM (I ApilcF Sacramento, California <br />DO NOT WRITE BELOW`'THIS LINE. <br />SC 6022A (1/971 <br />A 8700-22 <br />UNIFORM HAZARDOUS <br />1. . eatoi s US EPA ID No. Manifest Document No <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />H not required by Federal low. <br />C L: I 0 11141 2 ? <br />3. Generator'. Nome and Malang Address <br />A. State Manifest Document NumbeS� <br />�e/J8776757 <br />t, iT'f OF STOCKTON <br />1 <br />42J NORTH EL. DORADO, STOCVTGN. (�I� 11:.� <br />B. Sate C»neraloislD S h <br />- <br />1 <br />I. Generator's' 1 1 <br />t <br />1 <br />5. Transponer 1 Company Name 6. US EPA ID Number <br />C- State Transporters ID <br />t <br />1 <br />D. Tramporier's Phone <br />1709 ) <br />7.-Tionapdriei Comp`ad'y Name 8. US EPA ID Number <br />E.i Sbte Tronsponer's ID <br />t <br />F: Trampa tru, Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. Stara F tali s } <br />I24uUSTRIAL SERVICE on. co <br />�j G <br />I <br />U.730 SOTO ST, <br />H. Facility'. Phone <br />_. <br />- - <br />-Z <br />_ <br />11. US DOT Description (including Proper Shipping Nome, Hazard Class, and ID Numbed <br />12. Conminers <br />13. Total <br />1 A. Unit <br />No. <br />T pe <br />Quantity <br />Wt/Vol <br />1. Waste Number <br />SroN <br />PiOP!-RCRA HAZ�ARI?OL15 WASTE L.1GIUID <br />EPA/Other <br />G <br />E:.t <br />. •r . <br />N <br />b' <br />_ <br />Sore <br />E <br />EPA/Other <br />R <br />A <br />T <br />State <br />O <br />EPA/Other <br />R <br />d' <br />State <br />EPA/Odter <br />/. Additional Descriptions Fiat Materials Listed Above <br />r Handling Codes for Wastes Usted Above <br />STATER FROM MDNTCORING WELL <br />' - <br />c;. <br />d <br />15. Special Handling Instructions and Additional Information <br />:&PROPRIATE PF?I1T�.CT :'E CLOTIIING '-71T E: 1711 E. WASHRIGTON <br />"EFIFRGENCY CONTACT: 1.209) 5.51-9145" STOCK T ON, CA <br />I6 GFNERATORiB CERTIFICATION: I hereby declare that the contents of this consignment artfully and occuratelr, described above by proper shipping name and ora clax,,Nd, packed, <br />marked, and labeled, and ore in all respects in proper condition for transport by highway according to app ;cable international <br />and national government regulations. <br />If I oat o large quantity generator. 1 cemi(y that I have a proggrom in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicollr <br />practicable and that I have ideated 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 o good faith effort to minimize my waste generation and select the beat waste management method that is <br />available to me and that I can afford. - - <br />Printed/Typed N.1 -- / <br />Signature n .. <br />Mo.+ Day . Year <br />r <br />Js <br />T <br />17. irons iter 1 Acknowled einem of Racd t of Moreno <br />NPrimed/Typed <br />No <br />.yea �.-. <br />P <br />Ll— <br />i <br />18. Tram mer 2 6nowledoemem of Recei t of Moteriah ' <br />T <br />Primed/Typed Name <br />SignatureSignatureMonth <br />Doy Yeor <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />20. Facility Owmr or Operator certification of rec<iat al hazardous materials <br />covered by this manifest except as noted in Item 19. <br />T <br />Y <br />Primed/Typed Name <br />2— 4, Ti. �si'� <br />Slgnatwe <br />yf� <br />Month Day Yeacf r <br />/ <br />DO NOT WRITE BELOW`'THIS LINE. <br />SC 6022A (1/971 <br />A 8700-22 <br />