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_ California <br /> atViv �. n .e <br /> .. _....._..._ . . _._.. - -.. -, 7jee insTrucsrue use MULL . .yo "• s»pammem os sa.R <br /> Form Approved OMB No. 2050-0039 (Expire 9-30-94) Sacramento,9e) " .-.�••��--• -_...._. <br /> Please print or type, Form designed for sets m elite (12pilchl' infer. <br /> amrarors US EPA ID No. Manifest Document 2. Page 1 Inform dim in The shaded areas <br /> UNIFORM HAZARDOUS is requiredby Federal law' <br /> WASTE MANIFEST U 9S 8 7 2 i of 1 <br /> 3. c.n. starts Mani=g Addressk-j V cog /�• y fo A . .F -. s <br /> Moil �� 1 $ /ZGSN6 / V ��iV� C OS �i�Gaaeramlvl �L <br /> .. Generators Phone 3 — or <br /> FJ !a tr�'�` <br /> ro W. US EPA ID Number t. SIatB jeans ID 5 t - .1 r` <br /> 5. Transporter 1 Company Nam. Tats' rs's' .! 1 • . <br /> C AD 9 62 4 17 2 5v. <br /> �m NOR CAL OIL D 7 amaerrot rPh ` T +fit Y <br /> R 4?P'! '°Y A'# - 1 - <br /> 0. US EPA ID Number E Slate TTarnspork ID ; §hL <br /> 'vv 1: it h £: <br /> J7, Tramporror 2 Company Name �, `0.'k Pn ,•**""ff.. <br /> V4 ��T .ansporl r' Phn.M � i�sy,�a '` Y'?1Y * `.. <br /> 10. US EPA ID Number 0 Slate aril s ID; ; rV <br /> Fridlibc <br /> FE1,o'Sp y <br /> �ftRIE 69 <br /> YTS 13331 NORTH HWY . 33e e1 r a rr <br /> _VS PATTERSONT CA 95363 <br /> 12 Containers 13. Tartu 14. Un:r <br /> )OZ 11 . US DOT Description IncProper luding Per Shipping Name, Hazard Class, and ID Number) N Type Qut Wt/vol ) <br /> _ an �Y <br /> v� <br /> HAZARDOUS WASTE LIQUID N . O . S . t xt <br /> V 3 ORMA—E NA-9189 0 0 T T G EV <br /> G ` a <br /> n _ x � <br /> W N y To <br /> E EP <br /> R <br /> A s f <br /> iT <br /> It loo� O { A/ <br /> R g <br /> Wr <br /> d' <br /> � A fie, <br /> Waetaeiii iedo+` svs <br /> 000 <br /> � B TTtfM �➢WAST t ' ,x ; � . t >"r � � r <br /> A ,Z <br /> 0 ructions and Additional Information <br /> F APPROPRIATE PROTECTIVE CLOTHING <br /> r ? " EMERGENCY CONTACT : ( 209 ) 667-6692 " <br /> '# tili SEE E . R . G . 31 <br /> Id. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment ore fully and accurately described above by proper shipping name and are classified, <br /> Qpacked, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable federal, state and international laws. <br /> s V <br /> If I am ° targe 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 <br /> economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the presentand future <br /> ods threat ro human health and the environment; OR, if I am a small quontity generator, I have mode a good faith effort to minimize my waste generation and select the best <br /> °•, K waste management method Mut Is available to me and than I can afford. <br /> O Printed/Typed Name Signator /N f Month Dot - Year <br /> A/` AA I 8 9 <br /> T 17. TransporferA Acknowledgement of Recei t of Materials <br /> 0 A Printed/Typed Name Signature month <br /> th ,D% <br /> UA Is .TOE PUETT <br /> W 0 18. Transporter 2 Acknowledgement of Receipt of Materil <br /> as <br /> T Printed/Typed Name St Merrill) Day Year <br /> O : t <br /> W 19. Discrepancy Indication Space <br /> to <br /> U P <br /> A <br /> forZ <br /> 1 20. FacilityOwner or O erator Certification of receipt of hazardous moterials covered b this m fest except as noted in Item 19. <br /> 1 <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRtTf IIELOW THIS LINE. - <br /> White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A (12/91 ) - _ To: P.O. Box 3000, Sacramento, CA 95812 <br /> EPA 0700-22 <br />