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State of Colifomia--Environmental Protection Agency W _ 1.. .._.._ _F <br /> Form Approved OMB No.?950-0039(Expires 9.30-99) See Instructions on bccZ @ �- <br /> Please print or type. Form osigned for use on elite(12-pitcr +rifer. g ,_ Department of Toxic Substances Control <br /> �J Socramento,'Mifamia: <br /> UNIFORM HAZARDOUS <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Informatiori in the shaded areas <br /> � isnot aired b Fedora{law. - <br /> I WASTE MANIFEST Al— O tl i req Y _ <br /> �t I :2 7 :of i <br /> �. Generator's Name and Mailing Address <br /> .AN %E PUL ENTERPR.TSES <br /> o . 0- B0X 1107, STOCKTON. CA <br /> A. Generator's Phone j_r'}? ) ' 5 19 <br /> CV S. Transporter I Company Name 6. US EPA ID Number •^' <br /> `1Ut�' I AL 0-L C AD S 32 4 17 � <br /> O Jw <br /> al <br /> 111 IIII <br /> 7. Transporter 2 Company Name 8. US EPA 10 Number 7 <br /> J <br /> J - <br /> Q <br /> V 9. elsi F51c�i7 arp t and Site Address __ 10. US EPA ID Number <br />)Z 1700 S. St,Ti�rS , <br />-O 1S ANIGELLS I=lk, ,4 I 7 <br /> 10 <br />-J <br />�V 11. US DOT Descri12. Con <br /> ption(including Proper Shipping Name,Hazard Class,and ID Number) Containers 13. Total Id. Unit <br /> ) No. Type Quantity Wt/Vol <br /> Z `tC.;ft-PC---rl LiA.e�AP'DOUS 14ASTE =-_ OU l n <br />)� 1:WATE? & SLUDGE: <br />�3 E O O1 T T <br />)o N b <br /> co E <br /> v R <br /> o T I I I <br /> W O <br /> R s <br /> ac I <br /> W d. <br /> Z <br /> w <br /> V <br /> u.1 <br /> x <br /> w <br /> ac <br /> Z 15 Special Handling Instructions and Additional Information APPROPRIATE PROTECTIVE CLOTHING S 1 T` AblrF_=SS: <br /> CONT-ACT: <br /> _ . tit9? X41-314. ,2^ <br /> w SEE E.R. G3-0 N. WEST _V <br /> NE <br /> STOCKTON, ISA 9165-yt,1.f <br /> 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, <br /> Q marked,and labeled,and are in all respects in proper condition For transport by highway according to applicable international and national government regulations. <br /> V. <br /> J <br /> IF I am a large quantity generator,I certify that I have a pray ram in place to reduce the volume and toxiciy of waste generated to the degree I have determined to be economicailr <br /> a- practicable and that I have selected the practicable me"or treatment,storage,or disposal currently available to me which minimizes the present and Future threat to human health <br /> oC and the environment;OR,if I am o small quantity generator,I have mode a good faith eifort to minimize my waste generation and select the best waste management method that is <br /> 0 available to me and that I can afford. <br />} Printed/ y Na rL eJ t <br /> V (` Signa e Month Oay-. Year <br /> Z r ' ` <br /> w T 17. Transporter 1 Acknowled ement of Receiefdf Materials <br /> It <br /> W A Printed/Typed Name / A _ <br /> /�../ 1 Signature.' ,., `/ f on D <br /> ay <br /> w P <br /> u- 0 18. Transporter 2 Acknowledoement of Receipt of Materials - <br /> R Primed/T ed Name <br /> w T yP Signature Month Day Year <br /> H E ii <br /> Q R I <br /> V F 19. Discrepancy Indication Space <br /> Z A <br /> C <br /> I <br /> Pacilits,OwAer CoeraAr C46tification ai:pees o hazardous materials covered by this ma ' st esreeot penoAd in 19" 1 <br /> YPrinted/Tye' _ Signature i ` o �, , �Xear <br /> r ! I �� <br /> DO NOT WRtT�4E1dW IS LI E. - <br /> DTSC 8022A (4/97) <br /> EPA 8700-22 green.' 11ANSPCRT'c3 RE aU$ <br />