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Slate of California—Environrdenlal Protection Agency <br /> Form Approved OMB Far 2050-0039tfar us a 91ite IF I See Instructions On back of -ge 6. Department of Toxic Substances Control <br /> Please print or Type. Form designed for ase on elite IF -pitch -ifec _ Sacramento,California <br /> UNIFORM HAZARDOUS I. benerntoi s US EPA ID No. Manifest Docvmeat No. 2, Page I Information in the shaded areas <br /> WASTE MANIFEST Is not required 6y Federal law. <br /> r' A ( x 1 3 6 G 9 � D 9 '7 � t of 1 <br /> 3. Generator's Name and Mailing Address .,State Man f.0 Do' .sty, <br /> ELT'r G TV CON'rRACTORS EVT <br /> 20 W. TTIRNV R ROAD, LODI, CA 95240 B Smta Gene,olor,ID <br /> A. Generator's phone 1 299) 461-6317 <br /> ry 5. Transporter I Company Name 6. US EPA ID Number C. Ston,Tmnsporter's ID <br /> m <br /> D_ Transporter's Phone <br /> 7. Transporter 2 Company Name8. US EPA ID Norn E Slate Transporler's ID <br /> VF. Tron,perler's Phone <br /> 9. Designated facility Name and Site Address 10, US EPA ID Number G. Stare Facility's ID <br /> RAru>> ENVIRONMENTAL sERvrc s ��q©1 1�1010131SISI(I I <br /> do 1515 Srlrfrll RIVER ROAD, Ta?,ST SACRAMENTO, CA 95691 H Facdily',Phone <br /> CA bOO03556 L, _ 1-5747 <br /> 03 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12 Co^lalnars 13 T t.1 14 Unit <br /> 1q:rZ a No, Type Quantity Wt/Vol I. Waste Number <br /> �� NON-RCRA HAZARDOUS WASTE LTOUTn slate <br /> pp3 (OILY WATER) NAER096#171 223 <br /> �o N D 0 I r r M y G� EPA/Other N/A <br /> b. <br /> 0 E state <br /> 4 R EPA/Other <br /> a A <br /> Slue <br /> m O <br /> R EPA/0160- <br /> a <br /> d. <br /> Z <br /> w <br /> V EPA/Othor <br /> w <br /> ul 1. Addlional Desc iplions for Materials Listed Above Kf Handl'ng Codas `"r Wastes Listed Above <br /> ilA� }` 1ns +i�r L 6 <br /> .. d. .— <br /> c.-.... ;dz: <br /> Z <br /> 0 15. Special Handling Instructions and Additional Information L O <br /> z HANDLERS RE 40 HOUR OSHA/SARA TRAINED <br /> w AND USE NIOSH APPROVED PPE. <br /> = ENFAG .NCY CONTACT: (916) 371-5747 <br /> Q16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately describedabove by proper shipping name and are classified,pocked, <br /> V marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and ndlianvl government regulations. <br /> _ 1 <br /> If I am a large quantity generator,I certify Ihol I have a pro in place to reduce the volume and toxicity of waste generated to the degree I have determined Io 6e economically <br /> hpracticable and that I hove selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> O and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select I e best waste management method that is <br /> available to me and that I con afford. _ 1 <br /> } Print /Typed Nome' /r / Signature 1 / Month Day Year <br /> w ( ../� .s -.)x._�?`%� <br /> T I/ Trans orlar I Acknowled e 1 of ecai 1 of Materials 1 <br /> 0 <br /> w M Prip ed/Typed Nome Signature i" month Day year <br /> w P �JVVRO v V IN< l. �" <br /> w0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 IF <br /> Printed/Typed Name Signature Month Day year <br /> w <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> L <br /> I 20. Poch Owner or Operator Certification of receipt of hazardous materials covered Isthis maniksl exce t as noted in It..19. <br /> TI Name Signature Month Day year <br /> Y Kr�K t7E«. r I 1 101s y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(4/97) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS \\ <br />