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Slate of calilomia—EnvironmaMal Protection Agency See Instructions an back aF nage 6. Depertmmt of Toxic Substances Control <br /> Form Approved OMB No. 2050-0079 (Expires MIMI > Sacramento, California <br /> Flats" print or type. Farm desgned for use on sloe f 12pi1 <br /> 1 . Gerw.oro/s US EPA 10 No. Manifest Dacurt 2. Page 1 Information k: the shaded areas <br /> UNIFORM HAZARDOUS q s not required by Federal law. <br /> WASTE MANIFEST (1 � 1 � � 8 7 2 3 of 1 <br /> 7. Gene ccis N and Ma;rasg Address <br /> o /Y/'11 - 'j <br /> Uri) /� N k j V P✓ j stab ceaeEofe{> <br /> 1 5 /Zc.SN6 � / ( T t <br /> ,. Gerorata/s Phone 3 —O !O s'f F <br /> � 6. US EPA ID Number C Stott Trmdporferf.ID l >^` t -l•e•• <br /> 5. Transparent I Company Nome _ . _ ';P ` <br /> NOR CAL OIL C AD 9 82 4 17 2 5 �w <br /> _ <br /> 8. US EPA 10 Number E ' Stab TF spgrle/E 10 A tl"yf.+ tTTa +ys` Ty <br /> J 7. Transporter 2 Compaq NameJf` _ r <br /> VF3 T Grupo 41.Phapel3' ydam`-'; .iPr <br /> 10. US EPA ID Number G;:Slole txJ a Ib Y2F } C 'r2 b 4' <br /> M 13331 NORTH HWY . 33 MLF I yb, t " / d. wi t` <br /> NS PATTERSONr CA 95363 -:' � 't,. . - as'7f ° 11 nit <br /> 1 <br /> �.. � tX <br /> 12 Containers 19. Total <br /> 1 �. Unit t . <br /> O„J^ 11 . US DOT Description 4,sluding Proper Shipping Nome, Hazard Class, and ID Number) N T p Quant Wt/V 1 hFsdt + <br /> Ogg <br /> N .=- HAZARDOUS WASTE LIQUID N . O . S . s 3 " <br /> � 3 D ORMA—E NA-9189 0 0 T T G EPA(OHer��x �sw <br /> E Sloie`rr,". <br /> s N b. 'iTy'Ra> P gi <br /> cq E EPA' OIINr6`D$- " 4f: <br /> xr R { <br /> Y". rJ to <br /> C9 T <br /> Mr <br /> O EPA�Otlier <br /> " Slate ... :. <br /> d. <br /> , w <br /> tj : (Z� .DezcrlytkreTb Maledals:Lsted Abovesys;'t' ,.�y+Y{. q'�'M n k 1�1"s.+a ssdlmg C,6des` forWrliiaa•Itt <br /> iifedcA.bove . . <br /> it <br /> .4 <br /> i • <br /> S - Q 13. Special Handbng Instructions and Additional Information <br /> ` A;'? ' a APPROPRIATE PROTECTIVE CLOTHING <br /> ' ;5 ` Z " EMERGENCY CONTACT : ( 209 ) 667-6692 " <br /> SEE E . R . G . 31 <br /> Q 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, <br /> packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable federal, state and 'nenrnadonal laws. <br /> 11 <br /> If I am a large quantity generator, I certify that I have o program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future <br /> 11, <br /> threat to human health and Mee ents OR, if I a mall quantity generator, I have made a good faith effort to minimae my waste l generation and select the best <br /> _ waste management method that isavailableto me and that I can afford. <br /> 0 Printed/Tvaed Name Sign awr tM X Month Day Year <br /> o <br /> 17. Transparieril Acknowled ement of Recei t of Materials <br /> WR - Printed/Typed Name SignaNre Month Day, <br /> Aeor <br /> w : JOE PUETT 4 <br /> wo 18. Transporter 2 Acknowledgement of Fecal t of Materials Month Day Year <br /> r Prinbd/Typed Name Si e <br /> L s <br /> O <br /> W 19. Discrepancy Indication Space <br /> N <br /> V F <br /> A <br /> Z C <br /> 1 20. Facilityownerr Operator Certification of rec i t of hazardous materials covered b this at lest a eg1 a noted in Item 19. <br /> TPrinted/Typed Name Signature <br /> Mondt Day Yea <br /> Y <br /> DO NOT WR ELOW THIS LINE. <br /> While: TSDF SENDS THIS COPY TO DISC WITHIN 70 DAYS. <br /> DTSC 8022A (12/91) _ To: P.O. Box 7000, Sacramento, CA 95812 <br /> EPA 8700-22 <br />