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State of California—Heo"and Welfare Agency Department of Health Services See Instructions on backO age 6. Toxic Substances contra Program Please print or type. Forth designed for use on eine(11•prt wilier)• Sacramento.Caltomia UNIFORM HAZARDOUS 1.Generators US EPA ID No. Manliest Document No. 2.Page I Information in the shaded grecs WASTE MANIFEST C I A,:, 10 10 ,0 ,0 10 ,9 18 15 , 3 0 1 0 1 0 1 0 1 2 of 1 a not required by Federal law. 3. r�rarors Name and MCking Address .A,.State.Marutes!Document Number u P. 0. Boa 5811, San Mateo, CA 94402 &5rateGenerators D. 4.Generators Phone(415 > 571-2434/571-2428H Yt>�ffr11a61-t011F5t:6E6tQ 5.Transporter I Company Nome 6.US EPA 0 Number C-State,:Tronsporters t0 2 O 548- H & 48H & H Ship Service Company C 1 A I D I 0 10 14 ,7 17 11 11 16 18 1.D-Transporters PlKM L - 7.Transporter 2 Company Name 8.US EPA ID Number E.State Tra."porteff..ID I I I I I I I I I >F.Transoortees Phone. 9. sip N Sit Atldpess 10.U5 EPA ID Number G Stat r� xr" tlg�zc�e r_ompanylEI: a1 ¢E T1 7't 1 E 1,6 E 220 China Basin Street 19 San Francisco, CA 94107 CIA 1D 10 10 14 17 17 11 11 16 18 "H 45ho 5.43-4835 12.Contaxnen la Total 14 UM 11.US DOT Description(inciudinp Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I.Waste Number CL Stats rr y v G RESIDUE GASOLINE TANK EPAJ J12 NON-RCRA HAZARDOUS WASTE SOLID 0 10 1 T ,P 0 ,6 ,0 A A P cN b. Stare >. E EMPTY GASOLINE TANK 512 R ¢ q NON-RCRA HAZARDOUS WASTE SOLID 0 11 I0 1 TIP 0 4 10 10 0 P U Z T C. R EP..A/Other T o d co (V V I I I I o J.Additional Desacnpti"for Materials Listed Above,. <: K.Handling Codes toe Wastes Listed Above ..€3€1,.e1�t .css las. a b ontarng; gala s ne T s zrt�rted rsztYt airy f�2 w fo . txan axe z PR FILE 44 U 15.Spec al Handling Instructions and Additional Into rmafion LU JOB #9660 JOB SITE: ARCO AM/PM, 92076 0 24 Hr. Emergency Contact: H & H 4(415) 543-4835 800 E. Kettleman Lane ' W APPROPRIATE PROTECTIVE CLOTHING AND RESPIRATOR. Lodi, California c Q 16. GENERATORS CEiTT1FICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are cksssfwd. Z packed,marked,and k7beksd,and are in all respects in proper condition for transport by highway according to o0P4cable international and national government regulations If I am a large quantify generator.I certify that I have a program in place to reduce the volume and toxicdy of waste generated to the degree I have determined to be Z economically practicable and that I have selected the practicable method of ireahnertt,storage,or disposal currently ava,lable to me which minimizes the bresent and future w threat to human health and the environment:OR,lf I am a small quantify generator.I have made a good faith effort to minirn¢e my waste generation and select the best waste .= management method that a available to me and that I can afford QPnnted/Typed Name Signalise Monrtt Day Yea U 111 12 10 1 9 1 1 T 17.ircnsoorter 1 Acknowledgement of ce,ot or Materials C R Pnnted/Typed Name Signature nature Man', "'ay year Z S ROBERT V. PETRUCC I z,� 1 11 12 , 0 1 9 11 I w � C18.'rarsooder 2 Acknowiedgemont of Receipt of,Materials 2 R Pnnted/Typed Name Signature Month Cay Year wT 0 R 1 1 1 1 ! w rn F n 19.Decreoac/Indication Sooce U A I, e I _5 of �,60 0 A o n �} �/�avo 9 / j,y,7 � 20..=acijr y Owner or Operator Certlf'aation of recerot of hozaraous matencts covered by this manlfest except as noted in item 19. T Prmtea/Typed Name Signature Month L Yecf Y ' NOT WRITE BELOW THIS UNE. DHS 8022A(12/00) _ _-- EPA 8700-22 ; - 3