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Staff•of CairlarnrrEnvironm.mvl Protection Ag.nry See Instruetfons on back of page 6 Department of ToaK Substances Control <br /> arm Approved ome No 2050-0039 jbprres 91490 Sacram.nsa California <br /> to pant or yW Form denprred for use on entre(12pach)rypewriter <br /> I Generaiar s US EPA ID No Manifest Document No 2 Page 1 Information m the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal low <br /> WASTE MANIFEST CAC 0 0 1 0 2 2 4 1 6 8 1 0 7 9 of 1 <br /> 3 Gerirraror s Name and Moping Address A.7Sttete Manifest Document Number <br /> VALLEY WHOLESALE DRUG CO INC. ' ""��`� °`"` v r 9 2 8 810 7 9 <br /> �� r Y., _.:,sxR <br /> P 0 Box 2065, Stockton, CA 95201 S State Generators ID <br /> 4 Generator s Phone 12091 466-0131 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number C State Tramporter s ID <br /> - NOR CAL OIL CAD 9 8 2 4 1 7 2 5 5 D rran,parrer s Phone (209) 667--6692 ' <br /> 7 Transporter 2 Company Nome 8 US EPA 10 Number E State Tronsporter's ID "r t <br /> F Transporters Phone <br /> Q 9 Designated Facility Name and Site Address 10 US EPA 10 Number G State Focthty s ID a <br /> REFINERIES SERVICE " C1 AlDI 018131116161712181 <br /> 13331 N Hwy 33 H Facility sMaine <br /> Patterson, CA 95363CAD0831 66728 - x A7a-4444 <br /> 12 Containers' 13 Total I4 Unit JI 'TT <br /> 11 US DOT Description(including Proper Shipping Nome Hazard Class and ID Number) No Type ChiantiWt/Vol I Waste Number ?t <br /> _ aNON-RCRA HAZARDOUS WASTE LIQUID slate <br /> 3 G (WATER & OIL) O O l T T G EPA/Otha1,t,1 ; <br /> E <br /> Ib <br /> Ne State Ka <br /> N R EPA/Othervfri; :rid <br /> A c State �� ezM w <br /> 00 T M i <br /> A EPA/Other> 17 <br /> Sfti`# r <br /> at ai <br /> LU d StateLU <br /> V �EPA/0iftev",%, <br /> W � b <br /> Ln <br /> J Additional Descriptions for Materials listed Above I K Handling Codes for Wastes Lsted Above <br /> TANK BOTTOM WASTE � ' °' Is <br /> a i3} � <br /> RINSATE <br /> r, � e t x <br /> d _ <br /> '.t f r ty t ;° 4rI <br /> F <br /> 15 Special Handling Instructions and Additional Inlormaiton <br /> APPROPRIATE PROTECTIVE CLOTHING <br /> 'Z "EMERGENCY CONTACT (209) 667-6692" <br /> M GE 31 <br /> t- <br /> a 16 GENERATOR S CERTIFICATION I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and ore classified E <br /> � pocked marked and labeled and are In all res ech in proper condition for transport b highway accord) to applicable federal state and international laws <br /> Q P P P P P Y 4 W n9 PP <br /> V <br /> 'J <br /> if I am o large quantity generator I certify that 1 have a program in piece to reduce the volume and toxicity of -cite gecercied to the degree I have determined to be <br /> econoi iicolly practicable and that I have selected the practicable method of treatment storage or disposal currently ovailoblr to me which minimizes the present and future <br /> threat to human health and the environment OR if I am a small quantity generator I have made a good faith effort to mmimize my waste generation and select the best <br /> to <br /> wasse management method shat is available to me and#hot I can afford <br /> 'p Printed/Typed Nome Martin Thorpe agent for Signature Mani' Day ear <br /> } Valle Wholesale DrugCo. Inc. �r <br /> V T I 17 Transporter I Acknowledgement of Receipt of Materials <br /> w ° y <br /> U, Printed,typ Nome Signature yyyy Mon ay Year <br /> H <br /> v <br /> LLJ b-11 <br /> 0 18 ha s orter 2 Acknowled emeni of Receipt of Matenass <br /> w I Panted,Typed Name Signature Month Day Year <br /> 0, e <br /> w I 19 Discrepancy Indication$pace <br /> V A <br /> Z� C <br /> -� I <br /> i 20 raa6ty Owner or Operator Certification of receipt of hazardous materials covered by Otis mars&st Pxcept at noted in Item 19 <br /> TI Panted,Typed Nome Signature I Month Day Year <br /> DO NOT WRITE BELOW THIS LINE <br /> (hire -SDF SEMM THIS COPY TO DT5C VITHIN 30 DAYS <br /> DISC 8022A (7,921 To P O Box 3000 Sacramento CA 95812 <br /> EPA 8700-22 <br />