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'irate of California—Environmental Protection Agency Form pprove OMB No.2050-0039(Expires 9-30-94) See Instructions on back r' -age b. Department of Toxic Substances Control Please print orfype. Form designed for use on elite(12-pita., ,ewriter. Sacramento,California FPAy4D.Not Manifest Document No. 2. Page 1 Information in the shaded areas UNIFORM HAZARDOUS i-��•944�( I ;lr EE�;L7N I;•, is not required by Federal law. WASTE MANIFEST r � Q of 3. Generator's Name and Mailing Address A. State Manifest Document Number UI.TRAMAR. INC. 03 .JUN 4 PH 1: 56 -92215493 z 51-5 West Third Street, Hanford. CA. 93230 B. State Generator's ID 4. Generator's Phone00 7 114 IV in 14 14 3 p 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporte s ID 401995 O a0 D. Transporter's Phone H & H Shia Service Company Ir' 1A In 11) 10 14 1-1 17 11 11 4835 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporters ID 1 Q U F. Transporter's Phone Q 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID Mo H & H Ship Service Company CAD 0 0 4 7 7 1 1116 8 �.J '20 Terry A. Francois Street. H. Facility's Phone U-)< San Francisco. CA. 94107 A D 0 0 4 7 7 1 1 6 18 (415) 543-4835 U 12. Containers 13. Total 14. Unit CVZCV 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number = State5 l RESIDUE GASOLT2JF: TANK 44 ())�' G NON-RCRA HAZARDOUS WASTE SOLID 0 0 1 T P 1 0 0 O 10 P EPA/Other ri E coN b. state C0 E N R EPA/Ctther � A 0 O T C. Stare O R EPA/Other LU Z d State LU U EPA/Other v; J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes listed Above EMPTY 10,000 gallon tank last containing a. 01 b. w gasolppioone. Tank lnerted with dry ice for Cr a 4. PROFIL9,42566 0 z 0 15. Special Handling Instructions and Additional Information a JOB #12:102 JOB SITE: BEACON STATION, 4494 Z 24 Hr. Emergency Contact: H & H #(415) 543-4835 2155 E. Fremont Street LU APPROPRIATE PROTECTIVE CLOTHING AND RESPIRATOR Stockton, California -� 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, J Q packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. U If I am a large quantity 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 practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future a: IN '\ threat to human health and the environment;OR, if I am a small quantity generator, I have made a good faith a fort to minimize my waste generation and select the best e management method that is available to me and that I can afford. `Print d T ped Name 1 Signator Month Day Year IF V emt . Z T 17. Trans orter 1 Acknowled ent of Receipt of aterials - LU p Printed/Typed Name Signa` 7► MonthO Day8 0 Year alN P ::E w 0 18. Transporter 2 Acknowledgement of Receipt of Materials 1 Printed/Typed Name Signature Month Day Year ti 0 R N19. Discrepancy Indication Space U F A Z C I L I 20. Facility Owner or Operator Certifiaektion of recei t of hazardous materials covered by this manifest except as noted in Item 19. ' T Printed/T Signature Month Day Year Y 10, O NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 8022A (12/91) _ (Generators who submit hazardous waste for transport cut-of-state, EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)