Laserfiche WebLink
State of C,.F. OMB Nironmenbl Pro Etpi <br />�r 14t <br />Form Approved OMB No. 2050-0039 (Exytns 9-30-991 r <br />Please pant or type. Form designed Iw use on elite (18pikh) ly�er. _. <br />w <br />Z <br />Q <br />N <br />w <br />Q <br />Z <br />C <br />Zz <br />x <br />U <br />c. <br />N <br />O <br />Z <br />Fa,iiM+ <br />ml of Toxic Substonoes Control <br />acramemo, California <br />DO NOT WRITE BECOW THIS LINE. <br />DTSC 8022A (4/971 <br />EPA 8700-22 - <br />Green: TRANSPORTER RETAINS <br />1. Generator's U5 EPA IDN _ `y " . Manifest,Doc menlvNo . h <br />2 Psge 1 'P <br />In{ormalion in the shaded areas <br />UNIFORM HAZARDOUS. <br />1, .. ,I <br />is not required by Federal law. <br />WASTE MANIFEST <br />A O Oy 2 ? <br />9� 1 6 <br />of1 <br />3. Generator's Nome and Mailing Address <br />AhJNET_IE, HOAG <br />720 PACIFIC AVE., STOCKTON, CA 952019 <br />ued/" <br />` <br />209 474-7532O <br />• <br />A. Generator's Phone ( 1 . <br />♦. 'w Yi K v»,. ?i' !', { wh J. <br />3. Transporter 1 Company Name 6. US EPA ID Number <br />tloR SAL OIL C. AD 9 82 <br />4 17 2 55 a1 <br />7. Transporter 2 Company Nome 8. US EPA ID Number <br />9 t NoP9,h 10. US EPA ID Number <br />IN�ii t`' Ldew OIL CO.filly' <br />6' s ng' _ c -�X <br />1700 S. _S10-Fiff—ST. <br />e 1 <br />'fbnlh 3 :. M a+Fl.tH+'P <br />LOS.ANGELES, CA. 90023 C AP 0 99 <br />7 0 " <br />I <br />1415^ <br />1.2. Contain <br />13. Total <br />14. Unit '" <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />' �: <br />Quantity <br />WI/Vol 'o>s um t <br />No. <br />Ters <br />NOP!—RCRA HAZARDOUS WASTE LiGUiD <br />-- <br />C WATER & SLUDGE) <br />6.01 <br />T T <br />0 <br />G <br />G <br />d <br />.:: <br />E; <br />6. <br />N <br />.. <br />E <br />R <br />- <br />- <br />A <br />O <br />_. <br />d. <br />h :: f:k?-, <br />non'aD`s Qhoas7or Malenals Usted Above, '' C 5eFt ^;' <br />tiji�Yr1 <br />*d-� <br />��+i•M�` <br />M 4 <br />,� <br />::NandO <br />� <br />'YJpa al a <br />�_ A� <br />®.,i'��' <br />!Y .C� 1%,�"" ��� <br />�.d1��'�;p51�1't�I,J.F�'.�' .. <br />/a`3' f: h <br />4s"�� �iY>: <br />k' <br />��yyyy <br />1S. Special Handling Instructions and Additional lnformation <br />APPROPRIATE PROTECTIVE CLOTHING <br />tOE{. SITE: MY MINI MART ' <br />"EMERGENCY CCFdTACT:i209)54).-9145" <br />1756 N. WILSON WAY <br />SEE E. R. f , . S 71 <br />STOCK'TON, CA 952.05 <br />lb_ GENERATOR'S CERTIFICATION: I hereby declom that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and notionol government regulations. _ <br />If I am a large quantiy generator, certify Mat have a p Tom in place to reduce the <br />I have disposal <br />volume and toxicity of waste generated to the degree I have determined to be economically <br />the future threat to human heohh <br />practicable and that selected the practiceble methods treatment, storage, or currently mmiloble tome which minimizes present and <br />and the environment; OR, If I am a small quantity generator, I have mode a good faith effort to minimize my waste generation and select the best waste management method that is <br />availa6le to me and that I can afford.,.-----,: <br />_ <br />z <br />Prin / ped fJ mafford.,.-----,:Sign.Nr <br />nl ,.Tw <br />/Day„ <br />6 <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />A <br />Printed/Typed Name <br />-KEN <br />Signowre <br />^" <br />Month Day year <br />8 <br />s" <br />S. PUETT <br />i <br />P <br />a18. <br />7rons rter 2 Acknowledgement of Recei t of Materials <br />R <br />T <br />Printed/Typed Name <br />Signature- <br />f-. <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />- <br />F <br />- <br />- <br />A <br />_ <br />r .. <br />L <br />- <br />1 <br />20. FociliN Owner or Ooi*atoeteriificotion of 'ecepica JhQrdou, materials covered by thii <br />m nifest wce os noted in IN. 19. <br />T <br />Primed/Typed Nome r - SignoNro <br />_ <br />Month Day Ysar <br />T <br />.._ <br />DO NOT WRITE BECOW THIS LINE. <br />DTSC 8022A (4/971 <br />EPA 8700-22 - <br />Green: TRANSPORTER RETAINS <br />