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Stote of Coliforn,a—Ennromnenial Protection Agency Form ApprovecILOMS No 2050-0039(Expires 9 30 94) See Instructions on back of pc;ge Ei DeFariment of Toric Substances Conlru Please print qty type Form designed for use on ehre(12-pitch)rypewnler Sacramento Colffurnio UNIFORM HAZARDOUS I GEnerator's US EPA ID No Manifest Document Na 2 Page 1 Information in the shaded areas is not required by FedLral law WASTE MANIFEST C A= U 0 ) I Ef 7�. r Ii_! }d"} J a [) 3 o 1 3 Generator's Nome and Mailing Address L A State Manifest Document Number W. W. MILES 93553603 in F . O. BOX 1:88, LOS ALTOS r CA D40--4 B Stole Generator t ID CN 4 Generator's Phone (`41 4 B-F,706 co d 5 Transporter 1 Company Name 6 US EPA ID Numbcr C State Tramporter's ID T 0 NOR CAL OIL I_ A0 3 B-- 4 1l t]5 ` ` I I I D Transporter's Phone (209)66/ 209)66 l 6692 I 1��LL _4 7 Transporter 2 Company Name 8 US EPA ID Numb,r E State Transporter%ID a V F Tronsporier's Phone Q 9 Designated Facility Name and Site Address 10 US EPA ID Number G Stale Facility's ID CY ENV I F OPUR WEST C OF F OPAT I ON �� 13331 NORTH HWY. OS H Facility's Phone l_ n U PATTEF SON, s=A 35 363 1. D r } u 1 6 7 8 11 US DOT Description(including Proper Shipping Name Hazard Class and ID Number) 12 Containers 13 Total 14 Unit Z No Type Quantity Wt/Vol I Waste Number :r_ NODI-i rC F A HAZAF DOUS WASTE L I DU 1 D sr 2 3 G 3- (WATER P DIESEL FUEL ) o Ci 1 T Tfiles I� EPA/01her E d N b State z 00 E R EPA/Other o T c State ' go O " R EPA/Other P.s+c t t1 A-4 e.� e Z d R.I A-S g u v State 1 EPA/Othef ' 1 Adam' na 2 cr tons o �' " t as ,p �YE)e tp} f Matenal3`lfste'i{rAbore FT, a,tr{ �� "4 s �, +` «� f � r'"�� K Handhng Cada{for Wastes Listed Above x x c=aa4 xep i^k,ms� Tl, aAPPIp01, 95%ry` d QtESEt—,r,F,,, E11APPROX" 57-- 0,& Y l')Yi' to �t!<+•M1�i� .i 3 Z � r,�` t �.�a "s��wz _`<a��' ,��t 'i"�s� � � P o-•� ' r. 'r' �w t;�� t O 15 Special Handling lnstruchons and Additional Information APPROPRIATE PROTECTIVE CLOTHING JOB SITE: Z "EMERGENCY CONTACT: ( 2[ 9 )G67-663=" 1115 W. CHARTER Wfy ( z SEE E. R. G. 31 ST00-TON, CA 95206 r 16 GENERATOR S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified packed marked and labeled and are in all respects in proper condition For transport by highway according to applicable interactional and national government regulations a U a If I am a large quantity generator I certify,that I hove a program in place to reduce the'volnme and toxicy of wo a generoli.d to the degree I hove determined to be -� economically practicable and that I have selected the practicable method of treatment storage or disposal currently available to me which minimizes the present and future 0. threat to human health and the environment OR if f am a small quantity generator I have made a good faith effort to namnsize my waste generation and select the best waste rano ement method that is available to me and that I can afford ix Panted T ped Name Signature Month Day Year / 1610 1 14PZ6�� p Iret Z R 17 Transporter I Acknowled a nt of Recei of Materials LSJ N Printed/ ed are Signatu��-/ lytonrfjr _Day, ea s `/ U {�Pl fJ LLJf O 18 Trans Drier 2 Ackngwled amen!of Recm t of Molenals LU R Y Printed/Typed Nome Signature Month Day Year , le LL E -F 0 N ua 19 Discrepancy Indicotion Space cr) VF A I C _ I L20 Fanli Ow _ _- I tier or O erotor Cut+hcation of receipt of hazardous motenrls covered by this morufest circ t a. p. ..s naffed in item 19_ T Pentad/Typed Nama�—`/ r Signature ' / 'tet�� T-- _ �.�f Month Day Your DO NOT WRITE BELOW THIS LINE DTSC 8022A (9/93) e T -1`'r) P = OT EPA 8700-22 'J 'c 4 „�Iu