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fete of Celitomla—Health and WellaWAt,ency <br /> Form Approved OMB No.2050— Department of Health Seg <br /> of <br /> 0039(Expires 9-30-91 ToxicSubstancesartmControl Di. <br /> 'lease print or type. (Form designed for use on elite itch typewriter). .� Sacramento,Celii <br /> UNIFORM HAZARDOUS 1 D@neratora US EPA ID No. Manifest z/P. 1 <br /> / `� 'Do url nly'vo Y Information in the shaded areae <br /> WASTE MANIFEST of Is not required by Federal law. <br /> 3rGenpr N ' end alling Address / j r;� A. State ManiffeestQOo u n Numb/e1� <br /> ,Ivr��.,�: vt:? ..,.' ,/f))l(r � r i'aiy V�3OduT� <br /> ��pH B.rStele eneralor'e ID <br /> 4. Generator's Phone N f I )`/%„1. '��LI eI Gy )7 <br /> 6. Transporter 1 Company Name fill- <br /> US EPA ID Number C. Stele Transporter's 10 �.1. <br /> r. AI tied Piz troICUM C A L) 9 2 0 6 I 7 1 i 2 't 0. TrensporteraPhono c :i jU- a <br /> N <br /> 7. Transporter 2 Company Name S. US EPA ID Number E. Slate Transporter's 10 <br /> F. Transporter's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> iief Incrtes Service H. Facily'Pane3 <br /> U <br /> 1333I ti HHY 33 Patterson <br /> 7 Q CA 95363 C A JUS 13 111616 7ZII 0010)674-1444 <br /> O 12. Containers 13. Total 14. I. <br /> y, 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> No. Type Wtlyul <br /> �.I U ° ) 1t Slelet_a. <br /> n = G WASTEl a1 C014iiUST13LE LIQUID <br /> i`�' 1 T T " y EPA/O her <br /> N E b. <br /> A q State <br /> S A <br /> m T <br /> N O EPAIOiher <br /> ru R c. <br /> g State <br /> m <br /> EPA/Other <br /> w d. <br /> Z t State <br /> W <br /> U <br /> EPAI Other <br /> w <br /> m J. Additional Descriptions for Materiels Listed Above K. Handling Codes for Wesley Listed Above <br /> a <br /> im ti:iTtR F iU 1 1."iS/iTC ° /�/ b <br /> w <br /> C. d. <br /> J <br /> Q <br /> 2 <br /> O <br /> 16. Special Handling Instructions and Additional Information <br /> Z USE APPRUPR1ATL PikOTEC7IYE GEAR <br /> DESIaNATEJ FACILITY ENERGEWCY CONTACT 4 W0874-4444 <br /> GENERATOR E:4ERGENCY WiITACT .t ."rl <br /> U <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> EL and are classified,pecked,marked,and labeled,and are In all respects In proper condition for transport by highway according to applicable international and <br /> N national government regulations. <br /> It I em 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 <br /> O to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> present and future threat to human health and the environment;OR,it I am a small quantity generator.I have made a good faith effort to minimize my waste <br /> = generation and select the best waste management method that is available to mu and that I pan afford. <br /> W Primed/Typed Name <br /> (9 Signature Monts Day Yv, <br /> w <br /> WE T 17. Transporter 1 Acknowledgement-of Receipt of Materials <br /> Z R <br /> < A Prints 79p Name SI nature + <br /> N g r Month Day y,O P r4 �r hCG .r), F �j 1./ <br /> W O 18. Transporter 2 Acknowledgement or Receipt of Materials <br /> U T Printed/Typed Name Signature <br /> E Monts Dar' n <br /> = <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materiels covered by this manifest except as noted in Item 19. <br /> T <br /> y Printed/Typed Nme+ria <br /> as Signature Month Day yc <br /> ( . . . l ,.� <br /> DHS 870022/99) <br /> EPA 9700-22 Do Not Write Below This Line <br /> (Rev.999)Previous editions are obsolete. <br /> GREEM HAULER RETAINS <br />