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State of California—Environmental Protection Agency Form Approved OMB No.2050-0039(Expires 9-30-94) See Instructions on back )age 6. Department of Toxic Substances Control �13leasa'�i}int or type. Fort"designed for use on elite(12pitc..,.1pewriter. Sacramento,California UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas is not required by Federal law. WASTE MANIFEST C JA IL 10 10 10 1 � fl( S i4' i3t _ L 0 ' of 1 3. Generator's Name and Mailing Address t %-'i?,'+`� ! 1 A. State Manifest Document Nu be — ULTRAMAR . INC... ,215 1 5"5 gest Third Street. Hanford. CA. 3,)AN i is PM (: 56 B. State Generator's ID 4. Generator's Phone (2 0 9) 583-3347 co IHIYIHI013161- 101016111112 O 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's IDf„ggg N & H ShipServit~ D. Transporter's Phonee Company +' A D O 0 4 ? 7 1 1 6 3 .4.15 543-4835 J J 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID Q U F. Transporter's Phone Q 9. Desi nated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID V-qZ H & Ship Service Company CAD 0 0 4 7 7 1 1 5 8 �0 220 TerrV A. Francois Street tn< H. F«ilily4157 543-4835 Ll�a San Francisco, C.A. 34107 r A D 0 0 4 7 7 1 l b 8 t �U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit Z No. Type Quantity Wt/Vol 1. Waste Number N= �- RESTDUF 1ASOLTNE TANK State (7)�� G NON--RCRA HAZARDOUS WASTE. SOLID 0 0 1 T P 1 0 0 0 0 P EPA/Other ri E 0 00 N *ESTDUR ASSOCTATED PTPTNG S'oe513 `r E v R NON-RCRA HAZARDOUS WASTE SOLID 0 0 1 B A 0 1 5 0 0 P EPA/Other o A C)c0 T c. State O s R '� EPA/Other W Z d. State Z W U EPA/Other v>' —I f J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above EMPTY 10,000 ciallort tank last containing 01 b. 01 gasoline. Tank inerted with dry ice foo w , a PROFILEr#A256h C. d. Z 0 15. Special Handling Instructions and Additional Information a JOB #.1.2302 JOB SITE: BEACON STATION, $494 Z 1114 Hr. Emergency Contact: H & H #(4151 543-4835 2185 E. Fremont Street U.1 APPROPRIATE PROTECTIVE CLOTHING AND RESPIRATOR Stockton, California J 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, 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 FL'J economically pacticable 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 and the environment;OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can of 0 Pr' eq Name Si na Month Da Year IF ,�r , � g 0 3 0 8 9 3 U 4 Z T 17. Transporter 1 Acknowledgement of Res ' 1 of Materials zW p 3 Printed/Typed Name Signatui f Mon Day, Year S f,XLT V. PE�'i"f-i.�QGI , „L• 0 0 3 , F 0 18. Transporter 2 Acknowledgement of Receipt of Materials W TLL Printed/Typed Name Signature Month Day Year 0 R N19. Discrepancy Indication Space U F • A Z C I L _ I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest exrept.as na ed in Item 19. T Printed ped ame Signature Month Day Year Y O NOT WRITE BELOW THIS LINE. Yallow: TSC" ENDS CCPY TC GENERATCR WITHIN 30 DAYS. DTSC 8022A (12/91) (Generators who submit hazardous waste for transport out-of-state, EPA 8700-22 Dd.�:, ':rd o;oy of 'his copy and send to DISC within 30 dcys.)