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F <br /> alitale of Cfornia—Enviranmenlal Protection Agency <br /> armApprovedOMB No.2050-0039(Expires 9.30-99[ See Instructions on back Of a 6. Department of Toxic Substances Control <br /> lease print or type. Form designed for use on alite(12-pitch)lye_ ,nler. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page I information in the shaded areas <br /> WASTE MANIFEST <br /> A L CI 0 0 0 -5 1 3 1 d 1. r r 6 of 1 is not required by Federal law. <br /> FAmorM1gq=pr�Mailyn��dress A. Stale Manifest Document Number <br /> 132a2 E3CALQN—SELLC?YA 22091505 <br /> Er0.CALON, Ch 95320 B. State Generators ID <br /> 4, Generator's Phone (209 ) 8303 731 <br /> Fn <br /> rV 5. Transporter I Company Name 6. US EPA ID Number C.-State Transporier's ID[Reserved.] <br /> u"1 <br /> f ? 3HON HshZARD3 3OLUTIQN3 C A 0 0 0 0 5 i 6 4 9 T D. Tronsporter's Phone <br /> (000)748-7493 <br /> r o <br /> k 7. Transporter 2 Company Name B. US EPA ID Number E. State Transporier's ID[Reserved.] <br /> .�5 Q F-'Tronsporier's Phone <br /> !^J p ed Foy ISI d Site Address 10, US EPA ID Number G. State Facility's ID <br /> k &8c ig l C,Vi::��'°J�f <br /> L <br /> rk L 1630 W 17TH 3T <br /> �j0 LONGBEACH, CA 90813 H. Facility's Phohe <br /> Y" C 71. G (} 2 6 9 0 9 0 1 ) .: � (562)432-5445 <br /> \ 1 <br /> y j 11. US DOT Description12. Containers 13. Total 14. Unit€including Proper Shipping Nome,Hazard Class,and ID Number) No. Type Quantity Wf/Vol 1..Waste Number <br /> ! 2 <br /> Q.A53QRBENT5 S OIL State 223 <br /> z <br /> NON—RCRA HA.2M OU3 WASTE SOLID <br /> G 0 D i�L 7 5 0 P eP ryra <br /> f Q N 6. State <br /> 00 E <br /> 7 R EPA/Other <br /> 7 T C. State <br /> IJ m O <br /> R EPA/Other <br /> 1 d. State <br /> L - - <br /> w <br /> V <br /> EPA/Other <br /> .)AclkMt listed Above + ' z 'r a r'y ` 3} K: handling Codes for Wastes listed Above , <br /> F)" <br /> L � .. ..•:� .,,;. �,, vi'. �k, :� s xfKe� 7. _ r .-s:�r,-.. r }t'6 '� r.- <br /> Q 'alERGENC"I! CONTACT: ((300). 746-7449° . <br /> SEE: E.Ft_G. PACE #. 171 <br /> 1 16. GENERATOR'S CERTIFICATION: I hereby declare shot the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> marked,and labeled,and are in all respects in proper condition forirgnspnrt by highway accarding to app cable international and nationol government regulations. <br /> If I am a large yuantiy 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 economically <br /> CL practicable and that!have selected the practicable method of treatment,starage,or disposal currently avai€able to me which minimizes the present and future threat to human heaith <br /> .and the environment;OR,if I am a small quantity generator,I have mode a good faith effort to inimize my waste generation and select the best waste management method that is <br /> available tome and that I can afford. <br /> rd, <br /> Name, Sign ur - Month Day Year <br /> z � e 141V- �e �r EK(dv Com ' f� J v v { <br /> T 17. Transporter i ASknowledg t of Receipt of Materials <br /> R <br /> G Printed/Typed NaIG Signa Month Day Year <br /> S, I 1 S. a 1 q I <br /> 3 0 3 <br /> sL 0 18. Transporter 2 Acknow6cl einem of Receipt of Materials <br /> O T Printed/Typed Name Signature Month Day' Year <br /> E <br /> ' R <br /> f <br /> F)c 19. Discrepancy Indication Space <br /> F <br /> N z A <br /> t <br /> f <br /> L <br /> I 20. Facility Owner or Operator Certification of recei t of hazardous-materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature- Month Day Year <br /> Y <br /> DO NOT WRITE- BELOW THIS LINE. <br /> )TSC 8022A(1199) <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> :PA 8704-22 To, P.O. Box 400, Sacramento, CA 95812-0400 1y <br /> r'V <br />