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r{�rft' <br /> �, i required F <br /> e y0enenl? 1 :; inept' b. ..'of .lino ra I e era ewt4 <br /> WASTE MANIFEST - <br /> UNIF:ORIN'N ARD 11S <br /> - - p, State Manifest Dxument Number � <br /> 1004 <br /> 3, emw'a Name and Mailing Address \\gyp- —'R C. Anderson <br /> 894 <br /> 9 3 <br /> ,��fic,GAs & Electric CO.' ' ]^ 13. StatoUSA.wawiroto - <br /> �; ° "wo- SC. Fresno, CA 937A0 �, Stockton GLC HY H $ 6 0 0 8 7 9 8 <br /> a. Generator's Phone( 209 263-5215, C. State Transportar's ID <br /> g US EPA ID Number 6 D. Tranaporter'a Phone 800-759-4211 <br /> 5. Transporter,Company Name <br /> rter's <br /> 0. <br /> US EPA ID Number E. State Transports <br /> oPhon lD <br /> a : Transporter 2Company Name F.Transporter'a Phone <br /> ` r US EPA _Number! r O, State Facill 'a <br /> 9..Designated F,emlit9 Name and Site Addressi <br /> Cha�nni cal Waste1. Management/Kis amen Hi 11 s Facility K Facility's Photo <br /> 36251 Old Skyline Road _ A 0 0 6 4 6 1 1 7 -269 386.-9711 , <br /> Ketfiaman .Cit . .CA '93239 - _,z. cnntamara 3 OunM Unn ,' nrS Waste <br /> No, TYPa t/Vol.+.,t <br /> 1,. US DOT Description gnciedin9 Prgper Shipping Name.IlazeN Class,end b Numbed. State[ <br /> contaminated <br /> 'California Regula ted:Waste only " .soil <br /> a` - <br /> .X <br /> • s.. yy {va ` 1 a rr t Z–tvx fPAlOther <br /> ♦ +�. '".k`K�ert r' �1�yr +� r �. gyp^ t `" A'.. i � >� Y. <br /> d 't't •�,rf+i -��.",s a 3�{ r v Ye � A'•`S=e tvF � � r a.'� :' <br /> rW d. <br /> Z r <br /> ' l'�eti t+ -spy, s vYewJ'i ya •?q "" ."x rt >.. <br /> S.Y c '+ r ^'tna%*. ?.spy ieq•= r '!x!4'r• " <br /> m j' •? <br /> z <br /> fes: <br /> labra _ r <br /> ir. ati..fSpeol.l �t�t 10abtic(lory W Additload2� �,5ftk' '�, C'.� •i' � �'- � . ' <br /> c�i.Yg' ctOthinq 1f,rr -.r �l c*z <br /> z dilrtng'imloi:ding. ' Ytoar respiiea �� �, s 1 y �� <br /> i } <br /> U 78. acoordidg to aPPlfdbl°MamPtiwlaI <br /> live <br /> m r pordrtion for traeeport by hlphweY 'i A <br /> GENEMTOR'S CEfiT k�m �I.arM�lebele�d and ere M aN.,tresD�ta th�prape consignment era(aM end acgurateh described above by V 11 <br /> Proper°brPp a�a <br /> end are classified.Pa „ ' 1 IMw dsfermNad ! <br /> a•3. <br /> y - national government regulations. - am M place to reduce tt�volume and toziGtY d w t 9° �t ( N hycb mkdgiizee tM y rc;. <br /> M 1 em a large yuemfy generetor.i'tertih that 1 haus a Pro9r (eAh aMorl to faklimize my waste �y r,y! i:. <br /> to bee large quancidly tity <br /> "ctt�-sble end that 1 have selected the praclicebb method <br /> mall Quholrty generator M rt a lde•good <br /> 0 preaeM.end(dura threat to human health end the environment;ht13 Velkbb to mo and that I un aMard. <br /> > .generation and select the beat waste menegemsN Madh Day Year <br /> 0 Sig at <br /> Printed/Typed Nema, M U <br /> 1w T 17. TranaPorter 1 Acknowledgement of Receipt of IAetariala .. month Day Year <br /> w SING <br /> A Pdntedd//Typad Name <br /> O 3' [ ,`-- <br /> @` 13.Tranaponef 2 AcknaMedgement of eceipl of Materials - _ Y <br /> ., M` .De +Year'. <br /> `A Prkded/Typed Neme"7.. <br /> E r - <br /> z 19. Discrepancy Indiction Space - MAILED - <br /> F <br /> A <br /> C <br /> 1 <br /> L Month Dey Yee, <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materiae ered <br /> by this manifest except as noted in Item 11n9l /I S <br /> V Printed/Typed � <br /> KAt-) MAGA <br /> Do Not Write Below This Line <br /> DHS 3022 A 0/88) ' <br /> EPA 3700-22 <br /> (Rev.700 Previous editions are obsolete. I /� J / Yellow_ TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />