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stafM'df <br /> f >tileac� Ce .'"'U K ? i4 � Q l�','''✓ �� Department of Health$ ►rNka Welfare Apncy Toxic Substances Control 0►vtta�3ioen2030_0O3p(Exp$ i Sacramento,California <br /> Form App d19 <br /> p <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifbet 2. Page 1 Information the shaded areas <br /> WA TE MANIFEST D 1 1 6 h 0 0 mem l 1 4 y Federal law. <br /> °f is not re ui d b <br /> 3. Generator's Name and MaAddress Generating Site A. a Manliest Document INn <br /> Mai <br /> &p` r� Products CO. a7027311 <br /> AE 1 O, 944035 S�e���-�on erson Pia. ID state Ganarator's <br /> 4. Generator's Phone(41.5) 523"5366 Tracy. CA 95376 H 111 MIR 1315101 It 51 16101 <br /> 0 5. Transporter 1 Company Neme 6. US EPA ID Number C. State Transporter's ID <br /> tLn D. Trane orter's Phone <br /> . ; u 4 6 1 (� c .p 15 33-033 <br /> j N 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> o F: rAnaporter'a Phone <br /> 0 <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> Casmalia Resources I{� 1-24 <br /> J .. <br /> ¢ ir <br /> 3 ,. li Rd. H. Facility's PhoAe <br /> U <br /> ¢ Casnvl.l a, CA 93429 )� �; f r <br /> Z 12. Containers 13. Total 14. I. <br /> CrQuantity Unit Waste No. <br /> p 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) <br /> LL No. Type Wt/Vo <br /> J ] State <br /> G <br /> I E S - EPA/Other <br /> �1A2RYd0118 F/A3 ;�y Solid, N.C.O. 0-irT"E NA 9189 Y RC2tA EX-4- <br /> 3: E b. State <br /> ! NR <br /> o A EPA/Other <br /> I m T AIL Is& <br /> R <br /> C. <br /> State <br /> 0 <br /> U'Vt <br /> G9 G 'tor EPA/Other <br /> ¢ dSt <br /> W <br /> Z J� - <br /> Z <br /> C w EPA/Other <br /> U <br /> Cry <br /> Z J. Additional Descriptions for Materials Listed Above K.Handling Codes for Wastes Listed Above <br /> a b. <br /> Sail•emteninated with V a,ite oil/a lsikeis ted debris 100% Q3 <br /> �. <br /> C. d. <br /> N a See a*tached aualy'eis. <br /> 1p Z <br /> 15. Special Handling Instructions and Additional Information <br /> IODw .`.-ro_�' contand w1th eyes nd srin. <br /> J i + <br /> J 16. r <br /> i ¢ <br /> U GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of chis consignment@'fully and accurately d� bed above by proper shipping <br /> name and are classified, packed, marked, and labeled, and are in all respects in proper ndk rLfx1 trpn�por j F ighway according to applicable <br /> international and national government regulations.CL <br /> ttUU 11 <br /> If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste gegen,ted to the degree I have <br /> LL determined to be economically practicable and that I have selected the practicable method of trMET <br /> r..�tprAgel 6r"di4posal currently available to <br /> U me which minimizes the present and future threat to human health and the environment; OR[�fjti� Irqupntj(yigjnerator, I have made a good <br /> } faith effort to minimize my waste generation and select the best waste management method that i§ t11"me and that I can afford. <br /> U <br /> Z Printed/Typed Name Signature Month Day Year <br /> cc <br /> 0 Fc:� E`.-co Petroleum/Steve Welge J <br /> w <br /> i 2 T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> LU R <br /> Z A ted(,Typed Name S natu a Month Day Year <br /> LL <br /> O O 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> LU 0 "T Printed/Typed Name Signature Month Day Year <br /> ¢ E <br /> U <br /> ? 19. Discrepancy Indication Space <br /> A <br /> I I <br /> L <br /> 1 20. Facility Owner or Pperator Certification of receipt of hazardous materials covered by this manif t except as n ed in Item 19. <br /> T Pri /Typed Nam <br /> Y n urs Month Day Y¢ar <br /> /G 1 Ph,0/1 <br /> DHS 8022 A /87) INSTRUCTI S ON THE BACK <br /> EPA 8700-22 Yellow: TSDF SENDS THIS COPY TO GENERATOR WITH 30 DAYS <br /> (Rev.9-86) Prihious editions are obsolete. <br />