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Slate of Californio—Er,kim menlal Protection Agency <br /> Farm Approved OMB No.2050-0039(Expires 9.30991See Instructions On back OF , 6. Department of Toxic Substances Castrol <br /> Please print or type. Form designed for use on all(12-pik. w., vj'wr.:' SowmmRo,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 C A D 9 8 1 6 8 2 3 6 2 2 9 6 7 8 of 1 i,not required by Federal law. <br /> bo l`N_grneaadMtilia¢AddtestO A. State Manifest Dammam Number 25107496 <br /> 2211 N WILSON TWADYQC 1. <br /> „a STOCKTON, CA 95205 B. State Genermor's ID <br /> n a. Generatrr Phone 1209 1329-5483 <br /> sV 5. Transport,1 Company Name 6. US EPA ID Number -Cf State Tromparler's ID Reserved-] <br /> h <br /> Q° SHOP HAZARDS SOLUTIONS C A 0 0 0 0 6 4 6 4 9 7 D. trans ores Phone <br /> $ p " (800)746-7449 <br /> T 7. Transporter 2 Company Nome 8. US EPA ID Number E Store Transporter's ID lReserned.1 <br /> QF. Tramparter s Phone <br /> U 9. Designated Facility Name and Site Add,... 10. US EPA ID Number G. stateF ciI D <br /> d GEM-�RATICHO COMO", LLC. <br /> Q Z11855 IMTE ROCK. RD. <br /> cat H. Fac.iys Phone <br /> a� O RANCHO CORDOVA, CA 95742 ICIAID191810181014111913 (916)351-0980 <br /> Q 11. US DOT Description(including Proper Shl Name,Hazard Class,and ID Number 12, Containers 13. Total ]A Unit <br /> (V U P lin gpiling I No. TYP. Quantity Wt/Val 1.Waste Numbe <br /> i aRQ, Waste Flammable liquids, n.o.s., 3, Stare <br /> i 3 G UN1993, II (SOLVENT, METHYLENE CHLMID8) <br /> (D001,1*002) 0 0 1 D N 0 0 0 2 10 G "68h,F002 <br /> o N 6' stare <br /> m E <br /> R EPA/Other <br /> a A _ <br /> 6 T Stare <br /> m O <br /> R EPA/Other <br /> wd. Store <br /> Z <br /> W <br /> V EPA/Ott <br /> W <br /> h 1. Addifional Desch tions(err atenalr L'sfad Above K Handling Cedes For Wastes Listed Above <br /> gZ a) PROFILL� # �i30 , CHLCIRINATED PARTS �� ( . . 6 <br /> CLEANING SOLVENT & OIL `� <br /> W <br /> C d. <br /> t— <br /> AY �2S R A't artPR07ECTIVEaCLOTHENG <br /> Z "EMERGENCY CONTACT: (800) 746-7449" <br /> W SEE E.R.G. PAGE # 128 <br /> x <br /> t— <br /> j 16. GENERATOR'S CERTIFICATION: I hereby declare thallheconknls oFthis constrment.r.Fully and acinose,described above by propenhipping nam<and ora classified,packed, <br /> VQ marked,and labeled,and are in all respects in proper condition for transport by highwoy according to applicable international and national government regulations. <br /> IF I our o large quantity genemtr,I certify that I hme a p ram in place to reduce the volume and toxicity of waste generated t the degree I have determined to no economically <br /> i Uripracticable and that I=selected the practicable method of treatment,storage,err d' I currently mailable to me which minimizes the present and future threat to human heogh <br /> and the environment;OR,if I am a small quantity generator,I have made a goad f effort to minimize my w generation and select the best waste management method that is <br /> Oai mle to me and that I can afford. <br /> yPdn Ty d N"Z. Sigtsatr n Day ' Year <br /> Z <br /> — ^ O <br /> W T 17. 1ris"sperninrl Acknowied amens of Receipt of Materials <br /> k Prin typed Name SignaNro Month [ .Year <br /> w S <br /> P <br /> I VIA <br /> W 0 18. Turns 'ler 2 Acksowled emenl of Receipt of Materials <br /> 0 T Prirf d/Typed Name Signature - Month Day Year <br /> RE <br /> N <br /> 19. Discrepancy Indication Space <br /> Z P <br /> _ p <br /> C <br /> 1 <br /> L <br /> 1 20. Facilin,OxxistrisrO mtr CerflfimlionoFinai IafhazordousmaNrials this onifest exp s Asset in ltm l9. <br /> T Pr' ted/Ty N eW11 Sig nt <br /> JCALY <br /> D NOT WRITE BELOW THIS LINE. <br /> 27A II/991 Whit: TSDF SENDS THIS COPY TO DISC WITHIN 30 DAYS. <br /> DTSC 80 <br /> EPA 87022A 1 To: P.O. Box 3000, Sacramento, CA 95812 <br /> 6288 . 0069 <br />