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grate of Colilomio—Ensbomnar:tol Protection Agatay J <br /> Form Approved OMB No.2050-=9(Expitn 9-0694) ,,age b <br /> Sec instructions on 60� Department of Task Substances Co <br /> Plea»print or tyu»pe. Farm dong,u ,far on elite(12 ypawri»c S«ramenro,Califomia <br /> UNIFORM HAZARDOUS 1. Generator's US EPA 10 No. Manifest Document No- 2. Pae 1 gInfom:olion in the shaded areas <br /> - <br /> irl Al rI nini 01 gi -41 -41 Al 7141 f) <br /> WASTE MANIFEST is out required by Federal low. <br /> of <br /> 7. Generator's Name and Mailing Address $fate�/.ioaiiesf,Doeiiirierm•NV .- :-a...3= <br /> COUNTRY SIDE MARKET ' AY <br /> N LOS48 EASTCOPPEkOPOLLS ROAD. STOCKTON CA. <br /> h 4. Generators Phone (� ) <br /> 3. Transporter I Company Nome 6. U$EPA ID <br /> 0? Lie. <br /> J1ET!?UL lik - L" NCCORP, 5 1g� nn arts'+�a4W' y' � <br /> Q 7. Transporter 2 Co.,."Name 8. U$EPA ID Number nsp`pdezt ' ++ <br /> rteP � <br /> Q 9. Designated Facility <br /> . 4z Name and Site Address 10. US EPA ID umber? <br /> NO kITROLLUH kECYCLING CORP. <br /> LL�a1333L NORTH HIGH14AY 33 &Vu <br /> U s <br /> 12. Contains. <br /> OZ 11. US DOT Description(including Proper Shipping Name,Hazard Qou,ricer'ID Number) ofa 14. UM s <br /> A,= No. T Oscan' Wt/Vol {s�, <br /> ♦� _>s tiiAJ <br /> �� G NUN ACkA HAZARDOUS WASTE LI UID OIL 8 MATER 0 0 L T ~ <br /> 0 E <br /> m N b. C <br /> r <br /> A , <br /> T <br /> i O f-p��`�N <br /> WPV <br /> — <br /> Z d. v / <br /> w +' <br /> W <br /> N <br /> Z :J. Additional Descriptions for Mater»Is �r <br /> O ,+"r.-1r r ar ` $1{� to <br /> Jl,i <br /> � <br /> ap! <br /> �,�rnTB:?TTrA� Po, - <br /> �v <br /> p ' <br /> 1 <br /> Q 15. Spacial Handling Instructions and Additional Inlormmion <br /> Z 24 HR. EdUG -rCT CONTACT: 1-800-874-4444 <br /> = 24 81. BbIEYGBNCY RESPONSE: CHER TEL INC. 1-800-233-3924 <br /> 16. GENERATOR'S CERTIFI TIO I y ra of s caMsnh o a cons:gnmem are fully and«araroly described above by proper shippktglrame aad are classified, <br /> Q pocked,marked.and lobated,and are in all respects in proper condition for transport by highway according no applicable federal,sane and International lows. <br /> U <br /> If I am a lar,. nmralty yr n mra,, I certify Mor I It. a program In plate to '.duce ds.whim. and torld of wm» <br /> economically practicable and that I here selected the Practicable method of treatment,stor h' generated m ro the degree I how determined ut be <br /> 1 P q anhly g" soar d disposal currently avertable t i me which minimizes Ms and <br /> eel and future <br /> N threat m human nt methealth and the emtrmanentr r me if I that <br /> a small u rotor,1 haw made a good faits effort to minimize my waste Baneratlon and»lett Ma lent <br /> d, waste management method that h awilable»ms and Mot I can afford. I' <br /> O Printed/Typed Name !r Signaturi <br /> Month Day Ywr <br /> Z T 17.•Trankaorior 1 Ackrawled emam of Recti of MaterialsILA !� <br /> A P ped Name '1 gr' (/r Month Day Y. <br /> W0 18. T.,uponIsr 2 Acknoneirsdarnment of Receipt of Materials <br /> Printed/Typed Name Signature' Month Day Yeast <br /> w 19. Discrepancy Indication Space <br /> N <br /> VF <br /> A <br /> Z C <br /> I <br /> k 20. F.,ilhv Owner or O rotor Certification of receipt of hazardous materials severed b 'this manifest....W as noted In I»m 19. <br /> I <br /> YPrinted/Typed Name Signature Momh Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (12/91) <br /> EPA 8700-22 <br /> Yellow, GENERATOR RETAINS <br />