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State of California—Environmental Protection Agency - <br /> -. _...-- —:a- .. __... <br /> Form Approved OMB No.7J�50-0039 IEsspirss 9-30-99) Set:IE13�FOCfi005 00 I30C 98 6 Deportment of Toxic Substances Control <br /> Blease print'or ype. Form cosigned forum on @life(12-pi rite,. Sacramanta,'CSShhm,a - <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Informatimrin the shaded areas <br /> is not required by Federal low. <br /> WASTE MANIFEST AI' O 0 C 2 ' 7 8 of l a <br /> 3. Genermoer Name and Mailing Address - - <br /> AN DE ROL ENTERPRISES i <br /> P. C. PDX 1107, STOCWTON. CA 95201-1107ygY rqtilt <br /> h eneratorsone f" ) <br /> 4. G ' Ph �I� 4�E-592i )r i ;PSS`y :f� <br /> � ,: h e <br /> CV 5. Trans oder 1 Company Name 6. US EPA10Number spoitiiitt ID s sus s G <br /> ,�, V4P (PAL OIL C AD 9 32 4 17 2 v5 <br /> ds Phan u <br /> 7. Transporter 2 Company Name 8. US EPA ID Numberw . _ _ . <br /> Q - n %Rfjore kn �.z�Y-.�'�'t Y�- :--•t'§'t"� t-� <br /> V <br /> s q F ci a e n S' Ad ass 10. US EPA ID Number ity's ID S ` <br /> Dz 1700 S. SO�,ST. <br /> � @•� fir'-',. �,,tT._. <br /> •wo O5 ANGELES. CR. 90042 _ A '1 9- 5 7 <br /> 12. Containe3. Total I4. Unit - <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number <br /> �U N. <br /> T rs 1Quantity WF/V.1 <br /> V= JOa-RCRA HAZAPDOUS WASTE LIQUID <br /> n3 G (WATER & SLUDGE) O 01 T 13 <br /> 7�o N b, m%. <br /> m E EP <br /> a R <br /> a A a <br /> o T <br /> m O <br /> R ah,r <br /> Sae; <br /> Qc - <br /> w d. <br /> Z <br /> U <br /> =1 AddiM1onal DexnpM1ons(or)4aMta7s Usfyed Aboret y^�,.. 'r q$ Wastes I-i0ed Above•"c ,'' § '";�" 5. <br /> Z <br /> RIN�5ATE a a } <br /> c d <br /> 11 <br /> Q. <br /> FT <br /> 15. Speci.1 Hanafng imtrvr ons and Additional Information <br /> - PPROPRIATE PROTECTIVE CLOTHING SITE ADDRESS: <br /> Z "EMERGENCY CONTACT: (209't541--91451r 3230 N. WEST LANE <br /> _ SEE E.R. G. 171 STOC'KTON. CA 95204 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately dwribed above by proper shipping nom.and aro classified,packed, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable interactional and national government regulations. <br /> U <br /> If I am a large quarto q generator,I artily that I have a program in place to reduce the valame and tazicity of waste generated to the degree I have determined to he economicollY <br /> rL practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> H and the environment;OR,if 1 am a small quantity generator,I hove made o good faith effort to minimize my waste generation and select the best waste management method that is <br /> Cz ay.ila61e to me and that I can.(ford. <br /> O <br /> } Printed/ Y�.y Na e ) Signa e ` Montlt —Year <br /> w T <br /> R 17. Transporter 1 Acknowledgement of ReceipMf Materials <br /> A Printad/Typed Name �--� / Signature i� - �' 4toet1z' oy <br /> w <br /> u- 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> O RPrinted/Typed Name Signature Month Day Year <br /> T <br /> w E <br /> R <br /> Laj 19. Discrepancy Indication Space. _ <br /> Z F <br /> A <br /> C <br /> I , <br /> L <br /> 1 20. F.cilirygd.r OwOraaifi,ofion of poceipeSThozardous materials covered by this ma '/st e t no in 19. <br /> T Prinlad/Ty, signmur. o <br /> Y G—tDay , ar <br /> DO NOT WR,ITP/Bi­EL4WT41S LI E. <br /> DTSC 8022A 14/971 <br /> .EPA 8700-22 Gree,'. TRANSPORTER R:TAINS <br />