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Form Approved OMA No.2050--0039 Ifxpbes 9-74941 See InslrDCtions on back of Page 6. P Department of Toxic Substances Control Ptesrse p-0 or type, Farm designed for via on afire(ITpAchJFvrirer. / ', I Socromenfe,Cotham;. UNIFORM HAZARDOUS nerator's US EPA ID No. Manifest Documens'1s� 2. Pagell Information in the shaded areas G WASTE MANIFEST is not required by Federal low. CAC001 0224168 1 0 7 9 � afl 3. Generator's Name and Mailing Address A 1$tade Morufesf Doeumesd Number VALLEY WHOLESALE DRUG CO. , INC. "' fA ;. r 92881.079 P P. 0. Box 2065, Stockton, CA 95201 $, STate Gerserahir s ID xy5 A. Generotor's Phone 12091 466-0131 m 5. Transporter 1 Company Name 6- US EPA ID Number C State Tron.Vo.rter'i ID f C? D Trons rter s Phone ` NOR CAL OIL C A 0 9 8 2 4 1 7 21515 I� (209) 667-6692 7. Transporter 2 Company Name S. US EPA ID Number E. Stale Tronsportcr's ID U : F. Transporters Phone Q 9. Designated Facility Name and Site Address Z g fT 10- US EPA ID Number G State Fauhty s)ID rl— � REFINERIES SERVICE C A O Q 8):11 6 6 7121" 8 CD 13331 N. Hwy 33 I�. Facthty,Phane a C 95363 C D O 8 3 1 6 6 7 2 8 .;� Ann A7d_AA 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers .13. Total IA Unil co� P� �� 9 P ppi^g co No, I Type Ouantily Wt/Vol '1: Waste Number 1. "'NON-RCRA HAZARDOUS WASTE LIQUID 7N e (WATER & OIL) 0 0 1 T ITI . G CO N b. it Slater eo E v tv R EPA/C>ther T"s '. 00 T Statt. . i•9�'4i'rr: '•;ii5 _ 0 r; t R EPA/Other.,.., LU Z dLIJ . U w Z J. Additional Descriptions for Materials Listed Above Y s k t f K.'Handling.Codes for Wastes Listed Above., TANK BOTTOM WASTE y a' 4`t b. tx RINSATE h ; c t A. 4 7 i1 O 15. Special Handling Instructions and Additional Inlormotion Q APPROPRIATE PROTECTIVE CLOTHING Z "EMERGENCY CONTACT: (209) 667-6692"LU i G GE 31 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, III "J pecked,marked,and labeled,and are in all respects in proper condition for transport b hi hwa according to applicable federal,state and international laws- Q P P P P P Y 9 Y 9 PP� tJ i 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 hove determined to be econoi.dcally practicable and that I have selected the practicable method of treatment,storage, or disposal currently available to me which minimizes the present and future i NIhreal 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 cc waste management method that is ovailable to me and that I can afford. 0 Printed/Typed home Martin Thorpe agent for Signature Mon tJs pay , Year l U Valle Wholesale Dru Co. Inc. Z i i 17. Trans orter I Acknowledgement of Recei t of Materials Wa A Prinled/M Signofuro Month Day Year iw P -Lt o I8. Tra s orter 2 Acknowled emeM of Recci t of Materials - W a Printed/Typed Name Signature Month Day Year lL e _ 01 w . su 1 19. Discrepancy Indication Space V) U A Il Zi C 1 I , II I 20. Facility Owner or O_erator Certification of rec»i t of Fsozardous materials covered by this manifest_except_a_s.noled in Item 19. T o i Prinled/Typed Name Signature Month Day Yer w. P /}'t 7-1 71 Y /� LDO NOT WRITE BELOW THIS LINE. 'Nhite: T50F SENDS THIS COPY TO DISC WITHN' 30 DAYS. DISC 8022A (71,92) To: P.O. Box 3000, Sacramento, CA' 95812 EPA 870 -22 i _7 tel• )