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I <br /> State of Coldormo—Enwronmontol Protoo.on Agency <br /> Form Approved OMB No 2050-U039(Expires 9 30-96) See Instructions on back of page 6 Department of Toxic Subsswrces C.omrol <br /> Please print or type Form derpned for use on olds(12-pitch)typewrder Socramento California <br /> UNIFORM HAZARDOUS 1 Generator's US EPA ID No Manifest Document No 2 Page 1 lnformahon in the shaded areas <br /> WASTE MANIFEST �` rl of "net required he Federal law <br /> I J <br /> 3 Generator s Name and Moiling Address <br /> OARRETRO, INC. r <br /> 34�rt1 CP,�IINO CERES ,CA 85307 <br /> 02 4 Generator s one <br /> �+ 5 Transporter 1 Company Name 6 US EPA ID Number <br /> C? � <br /> J <br /> ALLIED D£TROLEUM r, A L 0 0 0 1 1 = 3 1114 7 <br /> Q7 Transporter 2 Company Nome 8 US EPA ID Number � w_�}tQ i <br /> V I <br /> d <br /> Z 9 Designated Facility Name and Site Address 10 US EPA ID Number ' <br /> AMERICLEAN, INC � <br /> `L 2570 ALI40NO CSR. <br /> U SILVER SPRING, NV 119,119 IN IV 10 19 1112 13 1511 4 111 13 a <br /> 1 l US DOT Description(including Proper Shipping Name Hazard Class and 1D Number 12 Containers 13 Total 14 Unit <br /> = P ( g pe PP q ) No T Quant Wt/Vol <br /> a <br /> 3 G 099 RCRA HAAARDOUS WASTE LIOUID <br /> C4 £ T T f' a <br /> m N b <br /> R <br /> r 0 T a <br /> Q <br /> ac R <br />' w <br /> � <br /> Z d <br /> LU <br /> V <br /> cr) <br /> w <br /> oC <br /> a + <br /> Z <br /> 0 15 Special Handling Instructions and Additional Information PCIK-UR AT: 749 E. CHARTE¢ WAY <br /> Q WEAR PROTECTIVE GEAR STOCKTON', CA <br /> Z <br /> w ?4 HR FACILITY 702-577.9,r%Ol l <br /> 24 Hid GENERATOR 2C9-537-0771 ", <br /> 16 GENERATOR'S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above byproper shipping name and are classified <br /> �< packed,marked and labeled and are ,,all respects m proper condition for tronsport by highway according to applicable riternotional and national govemment regulations <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 generated to the degree I have determined to be <br /> deconomically practicable and that I have selected the practicable method of treatment storage or disposal currently available to me which minimizes the present and future <br /> N threat to human heohh and the environment OR if I am a small quantity generator I have made a good fadh effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford -1 <br /> O Panted/Typed r S+gnahrre +r r`� Month Day Year <br /> Z 1 17 Trans er Acknowledgement of Reteipt of Materials <br /> U, <br /> A <br /> (� A Panted/Typed ams ^� / Signature / / Month Day Year <br /> If <br /> LU S <br /> Uj r <br /> � 0 18 Trons rfar 2 Acknowledilernerit of Receipt ofrials � <br /> LL 1 Printed/Typed Name Signoh+re Month Day Year <br /> O E <br /> R <br /> V) 19 Discrepancy Indication Space <br /> Q F <br /> V A <br /> Z C <br /> I <br /> 20 Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in item 19 <br /> Printed/Typed Name Signature } r Month Day Year <br /> it , �1_0 -A --,Tc-. <br />' DO NOT- WRITE BELOW THIS LINE <br /> DTSC 8022A (1/95) Green TRANSPORTER RETAINS <br /> EPA 8700-22 <br />