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nt Protection A&ncy <br />I OMa No. 2050-0039 empires 930-96) p See Instruct ons an back edge 6. Department of Toxic Substances contra <br />type. Form deNaned for sae on eiro 112-10A. -if—. 9 <br />UNIFORM HAZAR60US <br />1. Generators U5 EPA ID No. <br />Manifest Document No. <br />2. Page 1 <br />Information in the dswded areas <br />WASTE MANIFEST <br />C A L 0 0 0 1 1 5 0 8 <br />0 1 3 0 7 <br />1 <br />is not required by Federal law. <br />h <br />of <br />1. G�,,;erators Name and mg Address <br />PRODUCTS Cif] <br />A. Stare Manifest Document iksettbes :i <'r, 3r, <br />nCO <br />ATTN s NEAL <br />VENIPORT <br />P.O. BOX 90877 DAVENPORT Cf <br />E24ICAL <br />IAS ANGELES, CA 9G9 <br />a. state°ceneraraes <br />ne3V2-9..: <br />4. Generators Phone ?10) 58 <br />I3 Y �- E F'3 6`.0 <br />S. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporters ID. �s + <br />D ILLAR D TRUCK L NIC;, INC. CAD 9011161912, <br />8 019 <br />D. Tramponers f%one i; , <br />Q <br />7•4Transporter 2 Company Name 8. US EPA ID Number <br />E. State T.o�,`,� s ID <br />'F. Transporters Phone <br />Q <br />4 <br />Z <br />9. Designahtd Facility Name and Site Addreu 10. US EPA ID Number <br />CHEMICAL WASTE: MANAGEMENT t <br />G. FqalWs ID�� i <br />�` <br />35251 OLD SKYLINE ROA!]_ -:;T: <br />`` �'° <br />H. Facifdys Phone ( x <br />S <br />KOITLF.MAN CITY, CA 93239' C A T 0 0 0 6 <br />4 6 1 1 7 <br />11. US DOT Dexrip IOn ( -1-dmg Proper Shipping Name, Hazard Class, and ID Number) <br />12, Containers <br />13, Total li Unit <br />� <br />E <br />a; PGTROLIFMM HYDRO(UMON CCvTAhII�,`ATED SOIL) <br />No. <br />T Qua Wt/vol y <br />. NCx2 RCRA HAZARDOUS WANE SOLID�f <br />1 <br />E <br />001 <br />D 2'000 YtA <br />0 N b. <br />E <br />V <br />R <br />r't <br />Ai <br />o T <: <br />O <br />Stale�a <br />e R <br />TPAY4 2W <br />ONse►��,'� r <br />j %Cddrtwtwl Deseriptans for MateKah laird Above <br />r r <br />11�►at€ >?R01�'-XLE: #A 120 <br />-. <br />Handling antes-f>stedA'A'b�ve' ✓k L'&,� <br />K. H dli C <br />an odes for W <br />` pr <br />G# 171 <br />a• b: r <br />� <br />C. <br />15 Special Handling Instructions and Addrhonal Information <br />.dear P.P.E. (i.e., ru)11or gloves, rubber boots, <br />protective Clothing, respirator, <br />24 -;;cur �;1G>^�81iC�' TelaT�tione¢': <br />goggies, etc.) <br />SITt: ARCO #0449.3 <br />(� 2S) t 3•_ FJ .JU <br />205 tdOfZTfi Cr' NTER STR1`r <br />J :: 1.07-•112 PO4 09-30222 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are f <br />My and accurately described above by proper shipping name and are classified, <br />packed, marked, and labeled, and are in all respects in proper condition for transport by hiql <br />way according to applicable internotional and national government regulations. <br />If I am a large quantity generator, I certify that I hove in program in place to reduce the <br />volume and toxicity of waste generated to the degree I hove determined to be <br />economically practicable and that I have selected the practicable method of treatment, store <br />threat to human health and the envirorent; OR, 0 1 am a small <br />ms f he <br />e, or disposal currently available to me which minimizes the present and fvture <br />quantity generator, <br />waste management method that is available to me and that I can afford. 1 <br />made a good faith effort to minimize my waste generation and select the best <br />Printed/Typed pme ignature <br />..Mnth Year1 <br />yS <br />/ <br />} <br />LD� <br />!'4f <br />T 17. Transporter 1 Acknowfed ement of Occopt of Materials <br />NPrinted%Typed Name Signature <br />Month Day Year <br />P <br />R18. Transporter 2 Acknowledgement of Receipt of Materials <br />T Printed/Typed Name <br />Signature <br />It pay Year <br />E <br />R <br />19. Discrepancy Ind'eeation Space <br />F p <br />A <br />C <br />1 <br />L <br />1 20. Facility Owner or ODerator Certification of recei t of hazardous materials covered 6y this mo <br />ifest except as noted in Item 19. <br />T PrintedrTyped Name <br />Y <br />Signature <br />Month pay Year <br />DO NOT WRITE BELOWI THIS UNE. <br />DISC 00-22 (9/91j <br />EPA 87701)—Green: TRANSPORTER RETAINS <br />