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f. Farm Approved OMB No 2050039(Expires <br /> Department of Health Services <br /> 4 Please print or type. (Fwm designed for useone Toxic Substances Control Division <br /> pitch typewriter). Sacramento,California <br /> UNIFORM HAZARDOUS' eneralor•s US EPA ID No. Manifest 2. Page r <br /> WASTE MANIFEST C A a U Q 12,1114 f,� ''� 2 � �gglrr�ntlqo.i o1ntormaTlon in the shaded areae <br /> ii V .L }, s not required by Federal law. <br /> 3. Generator's Name and Mailing Address <br /> f JUt A. State GTIP JRM Manifest Document Number <br /> ,. <br /> 275 CNT LINE UD � <br /> TRACY <br /> �5376 ;; 8. Stale Generators 10 <br /> 4. Generator's Phone <br /> li <br /> 5. Transporter T Company Name <br /> B. US EPA ID Number <br /> C. State Tranaporter'a ID <br /> x� E TRUING C A 05A 7A0 <br /> Q. Trensporter'a Phone <br /> Q� 7. Transporter 2 Company Name 8. U8 EPA ID Number E. State Transporter's fp• <br /> 9. Designated Facility Name and Silo Address F. Transporter'e Phone <br /> TQ. US EPA ID Number G. State <br /> Facility's ID <br /> G2 SLEVICES OF CAURNIA — FWI M <br /> (� h <br /> Faellity's Phone <br /> iC PAID 19 i8igiWi5121716180CA —762- <br /> 5 <br /> 012. Containers 13. Total 14. L t <br /> r+LL t 1, US DOT Description(including Proper Shipping Name,Hazard Class,and 10 Number) <br /> r J Quantity Unit Waste No. <br /> U4 <br /> Ltr. No. TYPa WllVol IrZ U - FryRNIA r�4jLtirGV ASTE Ota S <br /> tate <br /> G / U n 0 2 } <br /> E ISU <br /> N <br /> E b. <br /> R <br /> A Slate <br /> I <br /> T EPA r Other j <br /> CN D Ir <br /> R e. Slate <br /> EPA/Other <br /> W d. <br /> �Zy State r <br /> U <br /> W EPA/Other <br /> to J. Additional Descriptions for Materiels Listed Above I <br /> Z i K. Handling Codes for Wastes Listed Above <br /> SOIL CONTAMINATED WIT}i OIL 81 GSE b. i <br /> C. d. <br /> Z i <br /> 15. Special Handling Instructions and Additional Information <br /> Z f / ��` L 1l 502 qtr i <br /> A' t �iUNES, GOGGLES & F' TECTIVL N'( JIMENT I` <br /> U <br /> GENERATOR'S CERTIFICATION; i hereby declare that;,the contents of this consignment are fully and accurately described above by proper ahipping name <br /> and are classified.packed,marked.and labeled,and are in ell respects in proper condition for transport by highway according to applicable international and <br /> r4 national government regulations. i <br /> It 11 1 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 1 have determined <br /> p to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> } present and future threat 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 ' <br /> generation and select the beat waste management method that Is available tlnL and that I can afford. ' <br /> Printed/Typed Name Signettae-_ Month Day Year <br /> r t i , <br /> WR IT. Transporter 1 Acknowledgement of Receipt of Materials <br /> Q A Printed r Typed Name 'I <br /> Signature <br /> 5 !f i --'--�-'...__.._. Month. Day Yeer <br /> Q P l f ± <br /> LU O 18. Transporter 2 Acknowledgement of Receipt of Materials i <br /> W <br /> R - <br /> t Printed rTyped Name <br /> U E Signature ANonfh Day Year <br /> Z RR I <br /> 19. Discrepancy Indication Space 1 <br /> F <br /> A <br /> C II <br /> I i <br /> L ; <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous malerisla covered by this manifest except as noted in item 19. i <br /> T <br /> Y Prinled/Typed Name Signature Month Day Year <br /> DHA 8700 A lea) <br /> EPA 8700-222 po Not Write Below This line <br /> (ftev.9.88)Previous editions are obsolete. _ <br /> YELLOW. GENERATOR RETAINS <br />