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+nronmentaltecuon e <br /> �iaN of Cal+fomto--EnA� m0 ,�,_, _ SA <br /> ��r .r rr� <br /> _EWtr"1ed oMB No 2050-001%,09 j�cp+res 9 30 991 See'`Instructfons on back of page 6. Deparnnent of Toxic Substances onto' <br /> 'lease print dM iYPe Form designed for use on ef+te(12 pitch)typewriter Sacramento California <br /> UNIFORM HAZARDOUS 1 Generator s US EPA ID No Manifest Document No 2 Page i Information in the shaded areas <br /> I n nos required by Federal law <br /> WASTE MANIFEST C A L 0 0 0 11 17 19 11 19 3 5 2 0 1 9 1 of <br /> 3 Tvgift s Kwrjcd tAjikegAA0mmpany site Location <br /> 2000 Craw Canyon Place Ste 400 Service Station <br /> San Ramon, Ca. 94583 i 6981 <br /> 4 Generators Phone(925 1 271--2305 <br /> + 5 Trons tier I Company Name 6 US EPA ID Number <br /> FULLER€XCAVAnNG AND OEM00 9 81443781 � <br /> } 7 Transporter 2 Company Name 8 US EPA 10 Number E �a1i ra Res" <br /> Fnporttira'{ one k <br /> c 1 10 US EPA ID Number G;Atola'Fac+hts;ID t''T 0 <br /> Wq <br /> t 266 PARR BLVD , <br /> RICHMOND, Cly 8480 C A D a 4 3 4 6 6 3 9 2 H� icff+ � nor <br /> 1 r n Pr a C d ID Number) 12 Containers 13 Total 14 Unit ` <br /> No Type Quantity WI/Vol i <br /> Non-RCRA hazardous waste solid TP P <br /> y c o 1011 112 10 10 10 <br /> '4 E b <br /> N <br /> a E <br /> R r <br /> a A <br /> T _ <br /> n O <br /> R <br /> � 3 <br /> d <br /> i <br /> J <br /> J <br /> n ����rryylpl�T <br /> I <br /> rRe <br /> . <br /> Number: Stockton Service Station <br /> r 24 Hour Emergency Contact, ndt L L #6981�/ ERG <br /> 16 GENERATOR 5 CERTIFICATIONE hereby declare that the contents of This consignment are fully and accurateI described above by proper ship mg name and are classified packed <br /> Q marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and nationo government regulations <br /> J <br /> If I am a large quantity generaror 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 economically <br /> 1 practicable and that I have selected she prachcabke method aF treatment storage or disposal currently available to me which minimizes Ike present and Future threat ro human health <br /> n I <br /> and the environment OR d I am a sora I quantity generator,Ijhova made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> x available to me and that I con afford <br /> Printed/Typed Name Signaturg Month Day Year <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> RPrinted/Typed Name Signature Month Day Year <br /> M <br /> I s <br /> Li <br /> 0 18 Trans er 2 Acknowled ement of Rec i t of Materials <br /> � Prini Ty dNam I^� Wkgn;�o Ih e�Day Year <br /> n R <br /> Q <br /> J 19 Discrepancy indication Space <br /> Z F <br /> A <br /> C <br /> E <br /> L <br /> 20 For ility Owner or O erator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19 <br /> W��a Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE <br /> Blue GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> DISC 8022A(1/991 To P O Box 400 Sacramento CA 95812 0400 <br /> EPA 6700-22 <br />