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b. Department of Toxic$vbno^cm Control <br /> State,of Cafrfo- 'ran d prot-tllon Agency �..'- See Instructions on back of './e. $acremen a,California <br /> Form A rased OMB .2 9(Expires 9.30.94) <br /> arm ned for use on dib(F2P�')bPe'"A�' Manifest Document No. 2. Papa 1 Information in the shaded areas <br /> pleose print or ss'Pe' 1, Oem,alo/s U$EPA ID No. is not required by Federal law. <br /> UN O HAZARDOUS °f <br /> E MANIFEST U ^CS <br /> 3. Oprorator's Name and Mailir Addross n'pf^c. Ave ve <br /> t <br /> Say,k 1,.1 (r:1 RS ;0'I <br /> n 4. Ce Iastor's Phone (�,((,I) �'f. -III N <br /> r 6. U$EPA ID Numbs, <br /> 5. TronspoAer 1 O"Pany Name <br /> 8 CAL 0 0 0 1 1 2 3 1 4 <br /> ALLIED PETROLEUM g, US EPA ID Number <br /> 7. Transporter 2 Company Name <br /> Q <br /> U <br /> Q 10. U$EPA ID Number <br /> O Z 9, Desi note Facility Nana and$Ite Address <br /> HEINRI -3 SEiiVICE <br /> M O 13331 N HWY 33 A D 0 8 3 1 6 1i 1 2 R <br /> N PATTERSOile f.A y53o3 C 2. Careainen 3. rural u. Unit a,:: <br /> Qd ID Number) T Quantity Wt/`rel .. <br /> U PF, g Hazard Cl..,Cla No. <br /> Z 11. U$DOT Doxripyan lincludinp Proper$hi n Name, <br /> M- ULU� u�L Wus c ��k• 6 <br /> M� a. Nu r T' (— U 1 <br /> I r E <br /> EP <br /> m N Is. s <br /> m E <br /> n R <br /> a A <br /> T <br /> I O <br /> R <br /> Z d. <br /> n' <br /> w <br /> n <br /> N <br /> Z <br /> n: <br /> R Y <br /> Q <br /> Z / <br /> 15, special Handling Instructions and Additional Information A <br /> g USE APPROPRIATE PROTECTIVE CEAR DO 874-4444 36 T IJJW. <br /> I DESIGNATED FACILITY EMEPGENCY CONTACT # v) <br /> Ili W GEWERMATOR Ei1ERGEl Y CONTACT #4-,v\ q>s1- III`I <br /> _ - Y proper Pp' 9 na <br /> n r tens,of <br /> for trampoA by highway according M oppF«abk federal,state and roam°no^°I laws. <br /> ~ 16. GENERATOR'S CERTIFICATION: I Mraby daclaro Mot the conronts of the condpnmam are Tully and accurately dexribed above b o er sh1 n me and are classified. <br /> �I f packed,marked,and labeled,and are in all respech i Pro have determ'rad m be <br /> \ S gree <br /> U I certify that I haw a rogram in place to roduce the vol omega.-.d toxicity <br /> lxcurtently available btmeed'which minimizes the present and Iuture <br /> If I can 0 large quantity generator, P <br /> h I ram a small quantity generator,I have mode p 9°°d faith effort to minimize my waste gmarohon and select be- <br /> if <br /> practicable and that I haw nt'.OR, <br /> the practicable method of heatment,storage, P° <br /> threat to human health and the environmenq Month Day V, <br /> t1f N waste mane amens-.,ad that is°wilable b me and that I can afford. /I Sign p 1, <br /> Q Printed/Typed Name ! <br /> S c <br /> U Month U <br /> 1 Trans Aer 1 Acknowlad em 1 Recei t o4 Materials $ignaNre �j <br /> w 2, Printed/Type ° <br /> j I w s d t of Mare.ials Month Day <br /> ` 0 18. Trans orter 2 Acknowled ement of $ig�,ssre <br /> v (I w <br /> j Printed/Typ°d Nome <br /> a <br /> R <br /> w <br /> 19. Dixrepanry Indication Space <br /> N <br /> I F <br /> U <br /> U A <br /> Z C <br /> i I — 1 Month Dar <br /> C" 20. Facili Owner or O rear Cerlifi<ation of recei t of hazardous materials covered b this manifest axce t as noted in Item 1 . <br /> 1 Signawre <br /> T Printed/Typ-d Nam- 6 <br /> If Geis <br /> I I I _ DO NOT WRITE BELOW THIS UNE. <br /> C Green: HAULER RETA� <br /> DISC 8022A (7/�) ---- <br /> EPA 8700-22 <br />