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Stgt of " 'ornic—Environmental Protection Agency 9-orm Approved OMB No.2050-W39(Expires 9-3094) See Instructions on back Id a 6. 9 Department of Toxic Substances Control Pleas e print or type. Form designed for use on elite(12pircn)typewriter. Sacramento,California UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas WASTE MANIFEST (1a'^ "' "�p t is not required by Federal law. C A I. 0 0 0 1 0 `Q;��i �..s33' �t 6`y}. {'iiI- � 1 of 1 3. Generator's Name and Mailing Address ' I'; ,j« ' A. State Manifest Document Number ULTRAMAR, INC. 525 test Third Street, Hanford . CA. 93200 JUN , (� p �; 1 ✓u tate Generator's ID LO 4. Generator's Phone CQ4 ) 583_334, X H 10 13 16 _ 10 10 16 11 It 12O 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID 0 402007 H & H Ship Service Company 14 11. ! 16 8 D. Transporters Phone- J (415) 543-4835 Q7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID U F. Transporter's Phone Q 9. esi nate facility Name and Site Address 10. US EPA ID Number G. State Facility's ID HE� S�iipService Company A0047711b8 0)0 220 Terry A. Francois Street �aLL 7 7 1 1 6 8 H. Facilfty4si ye 543-4$35 San Francisco, CA. 94].07 t JU �7Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit _ No. Type Quantity Wt/Vol 1. Waste Number N (YTL'ANL' WATER Stat. 3411.4 N� G NON-RCRA HAZARDOUS WASTE LTQUID 0 0 1 T T 7 G EPA/Other o E oo Nb. ao E State 4 04 R EPA/Other o A 0 T c State O R EPA/Other LU t- Z d• State w U EPA/Other J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above FUEL, OIL AND WATER a. 01 b. LU Q PROFILE #A2567 c. d. Z Q 15. Special Handling Instructions and Additional Information a JOB #12296 JOB SITE: BEACON STATION, #494 Z 24 Hr. Emergencv Contact: H A H #(415) 543-4835 2135 E. Fremont Street = 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, Vpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. 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 aeconomically practicable 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, 1 have made a good faith effort to minimize my waste generation and select the best a, waste management method that is available to me and that I can afford- 0 Printgd,4Typed Name Signatur C Month Day Year 3 10 8 19 1 3 Z T 17. Transporter 1 Acknowledgement of Recei t Materials w ``t MoDayear R OMh 0 s �Y3 rUr q Printed/Typed Name Signature a OO rs 1i.,i�1(<t! i D. �iifi U.1 P .- 1E 0 18. Transporter 2 Acknowledgement of Receipt of Materials .i T Printed/Typed Name Signature Month Day Year O R1 LU W. Discrepancy Indication Space a F Iters 13a) is reported in error; the correct Total Quantity is: 1057 (G) . U A Z_ L 1 20. wner or Operator Certification gf receipt of hazRulovs materials covered by this mani st exce t as noted in tem 19,1 T P nted/ ype Name Signature \� ✓ Month Dqy— Year V\ i �} DO NOT WRITE BELOW THIS LINE. Aow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 8022A (12/91) (Generators who submit hazardous waste for transport out-of-state, EPA 8700-22 produce como:ata.Joy a,a o t ` this copy and send tc CTSC within 20 .. 1-.i