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State ot'Colifornia—Environme I Protection Agency <br />;arm Approved OMB No. 205 3 Expires 9.30-96) <br />Please print or type. Form d •fined,For use on elite (12 -pitch) typewriter. <br />Q <br />tn <br />Ln <br />n <br />N <br />Ln <br />W <br />9 <br />W <br />J <br />Q <br />U <br />Q <br />2 <br />N <br />0 <br />J <br />W <br />H <br />Z <br />W <br />U <br />W <br />N <br />Z <br />0 <br />N <br />W <br />IX <br />W <br />H <br />J <br />Q <br />U <br />J <br />a <br />N <br />W <br />0 <br />U <br />Z <br />LU0 <br />tY <br />LUW <br />W <br />O <br />W <br />sn <br />Q <br />U <br />Z <br />1 <br />See Instructions on back gage 6. Department of Toxic Substances Control <br />c...,...._..._ r_i:s__:_ <br />DO NOT WRITE BELOW 'THISAINE. <br />t�jERAIOR WITHIN 30 DAYS. <br />Nnsre for transport out-of-state, <br />DTSC 8022A (1/95) <br />EPA 8700-22 -d send to DTSC within 30 days.) <br />UNIFORH ZARDOUS <br />1. Generator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />WAST M NIFEST <br />is not required by Federal law. <br />of <br />3. Generrator's.N}� a a. MailingAddress <br />/ f {/��� /% <br />AQP C(/` :3w A/O( ell 1 ,/`L�/' • <br />A. State anifest Document Number 96-117924,6 <br />hf 7 4 /p� <br />1 2 'T 6 <br />1 p/ <br />II <br />S+UG K 4, A C/ " I S X1 ;7 <br />^ V 9 V <br />B. State Generator's ID ; <br />4. Generator's Phone ) <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID <br />ALLIED PETROLEUM ICIAILIOIUIOIIII12131 <br />D. Transporter's Phone 209-576 -8500 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. ,State Transporter's ID <br />ITv 1 k LI ^.F S <br />F. Transporter's Phone �. <br />9. Designated Facility Name and Site Address 0. US AID um er <br />G. State ci' 's <br />A <br />) • �— <br />. 1� �' <br />H. F i YOne.... ,.,••cam' : i. <br />_ <br />_ •%�S%14+7�Y <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quant <br />"fi4P Vnfi <br />Wt/Vol <br />I. Waste Number <br />No. <br />Type <br />a. NON RCRA. NA.ZARIPOMS IA,'ASTE 1.1 1JI� <br />stare 223 <br />EPA/Other , <br />ET <br />n <br />N <br />b. <br />State <br />E <br />RECYCLINN G /TREATMENT AT THE <br />EPA/Other <br />C A prrvr,n <br />FOR <br />(rr( Ff,C'," ITY IN COMPTON, <br />T <br />([ <br />C. (P I _ f (- r1n i i �r 1-! �) TI 1 L -F 5SARYState <br />lFJ <br />o <br />01 -REAM <br />C.AS <br />EPA/Ork r <br />d. .. <br />State <br />EPA/Other <br />}. Additional Descr tT6hs for Materials Listed Above r r r' * ;w . + <br />K Ha ;o*g Codes for Woste4 <br />0-117 <br />Listed Above <br />b. <br />(ii w <br />r <br />aa- <br />0' Lr -0 00 - l <br />15. Special Handling Instructions and Additional Information E M e NN <br />WEAR PROTECTTVE GEAR Zoo 0 N • kt,W&DA 57 • os IPA 1 D # <br />FACILITY 702-577-9001 <br />ons G - g0ZZZ- <br />GEPIERATOR ­07�MQ G o <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the Ants o this dnsmAt are fu ly 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 highway according to applicable international and national government 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 />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and fYture <br />threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />waste management method that is available to me and that I can afford. <br />Printed/Typed Name <br />Signature I / <br />Month Day Year <br />R <br />17. Trans orter 1 Acknowled ement of Recei t of Materials �� - It <br />tl <br />Printed/Typed Name <br />Signature / <br />Month Day Year <br />S <br />! I <br />1 <br />P <br />0 <br />18. Trans orter 2 AWnawle"clfgernertf of Receipt of Materials <br />T <br />Printed/Typed Nam, <br />Signature <br />Month Day Year <br />19. Discrepancy n is ion Space L <br />F <br />A� <br />C <br />I <br />L <br />120 <br />Facili Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />A <br />-T <br />DO NOT WRITE BELOW 'THISAINE. <br />t�jERAIOR WITHIN 30 DAYS. <br />Nnsre for transport out-of-state, <br />DTSC 8022A (1/95) <br />EPA 8700-22 -d send to DTSC within 30 days.) <br />