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10r23it991 09: 50 FROM SE.h$CO MO.DESTO CA. DIU. TO 1464-"138 P.04 <br /> FormAppreved OMB No-2060-4089(Expires 9-W. t j TokiC Substances Co�strol Qivisia. <br /> P1aae�r1Yni a tj�e. (Fwm designed for use an alit =F$Ch fyyvwrirer). 4� <br /> Sacramento,Calftmir, <br /> UNIFORM HAZARDOUS t. Generator's US EPA IQ No, Manifeat' �. Pae t <br /> •• inlorrnati4n in the shaded ersas <br /> WASTE MANIFEST d o d 1, D,. _! at is not required by Federal taw. <br /> 3. Qene•tatar's Flame and Mqq'�lin A eas <br /> ,Aft? OT4 A C h�j 0 A slate Mani} u <br /> V <br /> ¢Op7 rJ'lII64w/ tori S�OC�Cir`CK <br /> y 4Sav a st8t .Ctienat+lW4ID . <br /> 4, Generator'a Pnone <br /> ,$ 5. Transporter t C.bMparry Name 0, US EPA 0.Number. C�:Stets Trattiepa#er s .:. .7' ', <br /> Allied Petroleum C .p.9j':8-.7.:.6:.T. S I o ;:r,n$t>Qtt.1A ate', F <br /> 7. Tran apo r�y'N ♦ � @ ' U$ EPA 0.Number::4PR -7 : E St'cts TranaporteCs ID <br /> $ v1 1F TranaparteYs•.P ) <br /> 9. Des led Fsttifity dame and 31te Address 10-- us FPA 0 Number. G3jMa F <br /> XdGty�*JO <br /> Refineries Service <br /> 0 13331 N HWY <br /> �� 33 Patterson _ :. <br /> CA 95363 C #) g <br /> 0.2 ! r' <br /> 72:Canfarnat•s. 19, Tdiaf <br /> U5 WT Description Unchm ing tipper Shipping Name."azard Cis" 9rid;0 Nmmbel�'. "', QusntftY :'IJn,Y :i;�%k/sale No, <br /> J.type /Vol <br /> �} a. <br /> WASTE FtIEL COMBUSTIB E.;Ll"16 state <br /> 1! NOS NA 1993 :� ::T:.T .�-�'dr ' G :'BAAr.t]tner:,_ <br /> N AE d.. <br /> A <br /> Tit <br /> EPA1Ctf1K•. <br /> o C. 3Wte <br /> EPA/0ttl@r;' <br /> LU <br /> 4 <br /> steba <br /> p •EPAi LU <br /> OIRer: <br /> J. Addi k"l Descriptions fpc Materials Listed e r r r <br /> Z ,r• , , adR' (vedeL tai wastes k+sted Above <br /> t.ew wt�f�S �! rpt <br /> 03 <br /> 4 Ii I TER:Ats+l� faxSAT �xirL ° 4?i5C ,� Mkt a ,r=r xf p ti <br /> - qqrr <br /> a ,b MTt F <br /> t6. spatial Handling instructions and Additions!fntarmetion' <br /> z USE APPROPRIATE PROTECTIVE GEAR <br /> DESIGI ATEA FACILITY EMERGENCY ACT.# '.�5�?8 =�$ <br /> GENERATOR EMERGENCY COATACT. # 4 9 I. ! . <br /> .GYRATOR'S CtEF"ICATION: t hereby declare that the contents oi.this!Otlda t�pKietJt'aro,f,ripr and aaaumlely dettrnbed above by pic"shipping name <br /> and are t:taasltlad.Peeked,marked,and labeled.and are In atl re'1lpWii.in pro <br /> per,catdNiata,for transport by higAwar ecr.Ordiny tO epClit able international and <br /> rr national government rtgylations. <br /> ¢ It i am a targe quantity generator.I certify that I have.a.pragtam in place.to.redirt a ttie'volrxh'e and-t"tty of v+a?t0 generated to the degree[have determined <br /> p to be economicagy preeticable and that t have selected.the praclicabis method d'trasUM4,storage,or.Sepaaat currently aveitabie to me which snh*nizes the <br /> present ane futery threat to human health and the evMrawnoo,on.if 1 am a'sntaR ttt+artt goad faith effort to minimize my waftte <br /> } gtt1.MR ratan..flava made s <br /> gtperativn and select fire boat waste management method that is syailapig ta.ate and fhai ECea'stftxd. <br /> PHMedlT Name. <br /> Month Gay Year <br /> R 17. Transporter r Acknowtedgement of Receipt of materisle <br /> a A PfLrea4rTyped Name Signal Morrtlr Day Year <br /> N <br /> p .w 4 <br /> L 4 t$.Transportar 2 Apk"wiedgement of Receipt of Matedaia.. <br /> d T Printed/Typ 5ignatrrre: '' <br /> CS Month Day Year <br /> E n �tL <br /> Qisofepanay tadiCation Space <br /> F <br /> A <br /> 1;1 , •` <br /> t 20- FRQ-0y 0-04rer Operator rwtdicatlon of receipt of.hazardoua matOriale Covered by mLe.memos;enoept:ae�notea in n;;is. <br /> T <br /> y printed/I yPeE Nrime Signature iVtoaLt DOY Veer <br /> DFt58022A(ttris) Do Ncf.Wrife Below Ttis•Lina. <br /> EPA 8700----.2 <br /> (nN.Q:s7 Previous ad;eivna are abaoiete. tkie, "NM70R.5 NDS TfiiS.C00Y-TO DOKS WfTHIN 30 DAYS <br /> ToE P.O:Box.400, 5ocictrriefity, CA 95812-0400 <br />