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A Cslit«nla—fleahh and Welfare Agency Department of Health Services- n Approved OM9 No 2050--0039(Expires 9-313, Toxic Sobslances Canird DMsbn <br /> P1 dnl or Porro des tied for use on 01H. 12 piftif f erHter. Sacramento.California <br /> UNIFORM HAZARDOUS t. General«'a US EPA ID No. Manifest r Pial t `M ietidn In'th�anado uu : <br /> WASTE MANIFEST I y c Docymfptro 1 is?V i ' ^9. rnrpgfliiedbyFederellw: <br /> ]. Generator's Name and Meiling Address A plate <br /> OMENS- IL 1. 111015 GI-AS6' CONTAINEP IIIC 1 .I'. <br /> PU BOX 30. TRr'J i, CA, ?g376 Vie. t <br /> D'1t <br /> a. Generator's Phone 1 ) 209-836-8227 `� " 'I <br /> 8"0 •f. <br /> e. Trengorler 1 DempnnY Mama I. US CPA 10 Number <br /> REFINEPILS SERI%'ICE I F 71 2 EaT <br /> 'n 7. Transporter 2 Company Name " <br /> m B. US EPA ID Number <br /> — g Deapnalad Facility Name grin She Address 10- US EPA 10 Number <br /> RtFINEPIES SERVICE <br /> 13331 r1. WHY 33 �.� r ;� -,�f; <br /> < PATTERSON. CA, 9536.9 „"� *� � a•.. <br /> bi F... ,vRvt <br /> t t. US DOT Description(including Proper Shipping Name,Hazard Class,and 10 Number) 11. ConlaNen 13. Tp1al la �7`4 <br /> Wain r <br /> < • No. Type +h ()rill L4_:.`5.pN1e � �• <br /> U <br /> WASTE. r+.O.S. . Oil., COMBUST 113111 <br /> z E LIQUID, HAIc 'rl (OIL AND WATER; <br /> r- <br /> .� E It 3?' <br /> r R <br /> m A <br /> T <br /> F <br /> gi d <br /> lu 1r -- <br /> W F <br /> J. Addigonel Descriptions for Mill Listed A" <br /> w <br /> ttlk'HINE OIL, NATER ' <br /> GLASS CONTAINER MANI-FACTURT <br /> 2 y� tY <br /> �- 15. Special Handling Instructional AdAdditionalalion :.ional Inlorm <br /> < <br /> Z <br /> w <br /> J <br /> J <br /> ` <br /> is <br /> U GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accwal de <br /> J nems end are clenailied. packed, marked, and labeled, and are m all respects in eN �' d above by Groper ahlppeq <br /> inters <br /> .,rd <br /> a" national p pro er condllion for Ire naport by highway aq <br /> a govemmeM repWatiooe. g Y ordlrp Ip eppeubN <br /> N If I am a lar • y g <br /> 9 be emit enamor, certify, that I neve a program in place pr reduce the volume and trent. of reale generated Ic the degree I have <br /> O determined to be economically present <br /> practicable and that I have selected the practicable method of lam a sm alorege, or disposal curtemly available to <br /> me which minimizes the waste andgen IW ure areae to human health and the emironmenl; ON, 1}I am • small Quantity geeeolor, I have made a good <br /> > faith effort to minimize my waste generation and select the beat waste management meth that is available to me and that I can afford. <br /> U <br /> Z <br /> W PrinbdlT of Name <br /> J MC KENZ I E Sign g / Mo+rm D r y <br /> w vD <br /> R t 7. Trensportar 1 Acknowledpemanl of Receipt of MetedaN , <br /> < A Panted/A: dN e- Signature <br /> O P <br /> w O 18. Transporter 2 AcanOW Qemenl o1 Recepl of Material, <br /> < R Prmled/Typed Name <br /> U T Slgnatwe <br /> E I.zarlfn Day Year <br /> Z_ <br /> tp. Dia«epancy Indication Spsce <br /> F <br /> A <br /> C <br /> I <br /> I 20. Facility Owner or Opera«Certdicstbn cei 1 d va r covered this manifest except a noted to earn Ig. <br /> T <br /> Y Signator <br /> FSI/ l— Mont y r <br /> OKS W22 A(t/87) <br /> EPA Ii Yellow: TSDF SENDS THIS COPY TO GENERATOR (THIN 30 DAYS INSTRUCTIONS ON THE BACK <br /> (Rev.9-9e) Previous editions are obsdete_ <br />