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Slate of Calilemia—Em,ironmsNal Protection Agency Wat/ mt� <br /> Form Approved OMB No.20504)C39(Expires 9-30-991 See Instructions on back of page 6. Department aF Talc substances Camrol <br /> .Please prim or type. Form designed for use an alit(12-pitch)"writer. ' <br /> Sacramaass,Calihrnia <br /> UNIFORM HAZARDOUS 1. Gmserato:s US EPA ID No. Manl9n D....,No. 2. Page I Informal—in the shaded areas <br /> WASTE MANIFEST '� is nm requiredby Fdwol'aw. <br /> 3. Gxnamr'a Name and Mailing Add.... TT— A State'Manifest Document Number <br /> L- <br /> 'Pass . F , 22127672 <br /> B wale Ge«aror:to . <br /> nA. Generator's Phone T"L.Cz gl f C"4 <br /> C4 5. Transporter 1 Company Nome 6. US EPA ID Number C Smho Tnm,,n.ra ID FR.serwd.I <br /> $ nv C A. 8 0 0 0 101017101113 1) T`dn>PorN/k Phone <br /> N� 7. Tromporter,2 Company Name B. US EPA ID Number E.-SIaG T,nspamr's ID{Rs;pm_ed.j r <br /> j F. Transporter's Phone <br /> s 9. . clad Facile Nome and Site Address 10. Us EPA ID Number G. srot a"'y <br /> GVa ALVIMINDEPENDENTOIL <br /> 5002 ARCHER STREET x Feciliy,Phon. <br /> cl.,i 0 ALVISO CA 95002 ICA1110,10 0 11161117 4 3 (510)476-1710 <br /> 11. U$DOT Description linduding Proper Shipping Name,Hazard Class,and ID Number) 12. COmainera 13. Total 1A. Unit <br /> No. T Oun,sasty WVv.I 11. Waste Number <br /> (ae.-e. NON RCRA HAZARDOUS WASTE, -sro» <br /> 3 LIQUID 001 T 7 G EPA/Oth.r <br /> .N b. shote <br /> m E <br /> R EPA/011ier <br /> e A Stateo . T <br /> m 0 <br /> R EPA/0ther. <br /> w d crop <br /> z <br /> Z <br /> V I EPA/OtMr <br /> w <br /> s^ 1.Additional Oscriprionsfar Minermisiistd Above X. Handling od.a 1 WmM liaNdlAbov <br /> ZO 17A <br /> b. <br /> d <br /> rn <br /> uss c:.. d. <br /> Q <br /> 0 V�IRappE"I'g�1ERGE<bC¢t6WI (C°F!KIRK HAYWARD 51"76-1740 ERG# 1 <br /> ti <br /> ti <br /> z <br /> z <br /> 16. GENERATOR'S CERTIFICATION: Ifni declare that the consintr of thla can.!g rdre lullyondoccumrel dascn6edobovebyproperahip ing..oma and we<Imsi/id,pmked, <br /> V marked,and 6 <br /> 6e1ed,and are in all aspects in proper condition hr hanapon ey hig6way acc.ndir,Io app(.mble inlarnaiimml and nationV,,r,i rnment regulations. <br /> J IF I ism a large quantity g.nwaro., certify has have a prop m is place ro reduce the valine end hoxialy of wait.generated so he deg,.I have determined to be ecanomiwit <br /> a Prac&a61e and that I hove lechod the p actio.N.method of neatmen,sera...or disposal wrrently wailab6 to me which minimizes the pr .t and fim re threat to human heall�i <br /> w and this environment;OR,.F 1 am a seasllrquamll....areror,I have made.good hi efion ro minimi..m waste generation and select the ben wave management method that is <br /> s avail.bk to me and drat I can oFlord. <br /> ZAftPrinmd/i dName rSignature r plondt� r0oy res. DYwr <br /> r 17. Tran er I Ackrmwl mens of Rewi r of MandatetiesE/ VX <br /> A Printd/T Name Signature Inlh Day Ywr <br /> � g d Q/ > $ <br /> w <br /> w 1 18. Trans net 2 A,know int ss of Recai t of Materials <br /> O Printed/TYPd Name Signature Month DaY Year <br /> � A <br /> V19, Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I r <br /> 20. Focil! Cwm w O rot C-66c F rat t of hazardous materials ow n.P.sl moes'as n <br /> T PrinNdfrypd Nam. e. Si a nth Do, Year <br /> Y 07 .f./1.J7. <br /> �/. Lam/ IZ <br /> D N W ITE BELOW THS NE. <br /> 8022A II/991 '. White: TSDF SENDS THIS COPY.TO DTSC WITHIN 30 DAYS. <br /> °TSC <br /> EPA B022A 1 To: P.O. Boz 3000,SooatiLerb; CA •95812 <br />