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State.of Colifomio .vironmw,W Protection Agendr - <br /> - Form Approved OMS No.2030-0039(E>�ires 9-3096) See Instructions O[I'back b. Department al Toric Substance Ccs <br /> Form designed far um or,efts{72pWlx� Sac thensh ded areaPlease print or type. � I <br /> 1. Generators UVEPA ID No. Manifest Document No. 2. Page 1 Infarrttation in the shaded areas <br /> UNIFORM HAZARDOUS 4 <br /> is net required by Federal law. 1 <br /> WASTE MANIFEST Q I Q •� 4 —T `7 S of ` <br /> 3. Generators Name and Mailing Address <br /> 0 <br /> HMR RANCH <br /> P.O, 8QX 908 t4ILLBRAE, CA 94MO <br /> C14 .. Generators Phone (415) 697-1655 <br /> 00 <br /> d 3. Transparror 1 Company Name 6. U5 EPA ID Number <br /> O ' <br /> ALLIED PETROLEUM CA0 0 0 -111t213111 <br /> L 4 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> a <br /> U <br /> nd <br /> 9. Desi gated Facil' Name and Site Address 10. US EPA ID Number <br /> o AM �ICLI:' , z�4C <br /> CNJ u_ 2570 ALMOND QR. <br /> a SILVER SPRINGS, MY 89429 N V D 9 13 2 3 5 8 4 8 3 <br /> >~ U 12. Containers 13. Total E4. Unt <br /> +^ Z ii. US DOT Description[urduding proper Shipping Name.Hazard Class,and ID Number) No. Type Quantity W}/Yol <br /> NON RCRA HAZARDOUS WASTE LIQUID <br /> 3 G T T o G <br /> ct E <br /> CD N b. <br /> E _ - <br /> C4 R <br /> A <br /> T c. <br /> O <br /> It <br /> w <br /> Z d. r <br /> LU 1 <br /> U - <br /> a' w <br /> - <br /> 0 <br /> LL) <br /> C <br /> a <br /> O 1s. I Ha dile In .ted ' nal information PICK-UP AT; GOODYEAR TIRE & RUBBER CO. <br /> a , R RI T 11c r. i 3 1151 MOLLY DR. <br /> Z <br /> `FACILITY 7412-577-5001 TRACY, CA <br /> GENERATOR 415--697-1655- <br /> –' 16. GENERATOR'S CERTIFICATION- I hereby declare that the contents of this consignnsmt are fully and accurately described above by proper shipping name and are classified, <br /> ' V pocked,marked,and labeled,and are in all respects in proper condHion for transport by highway according to applicable international and national government regulations. e <br /> i .. <br /> If t 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 I have determined to be <br /> economically practicable and that I have selected the practicable method of treahnerd,storage,or disposal currently available to me which minimizes the present and future <br /> CL <br /> N threat to human health and the ori ironmeNs OR, 9 1 am a small quantity generator,I have made a good faith_effort to minimize my waste generation and select the best <br /> �. waste management method that is available to me and that I can afford. <br /> O PrintedlLTyJpted Na Siq r ae Y _ J Montle Year <br /> 17 <br /> wT 17. Trans;:;;j;1 A knowfed ens Receiptof Materials 1 /' <br /> A Printed/ 5igtwNre y ff ,% MoTalnth Day Year <br /> /;� kle Ile I <br /> 12L�2 <br /> 6— <br /> Uj o 18. Tramr 2 Acknowled smogs ofACSiPtOf Mattriah <br /> 1 <br /> Month Day <br /> . - <br /> U_ I Printed/Typed Name <br /> SignatureYear <br /> 1 <br /> 0 <br /> ywj 19. Discrepancy Indication Space <br /> Q <br /> V FA <br /> Z C <br /> 1 <br /> L <br /> 1 <br /> 20. Facility Owner or Operator Certification of r"pt of hazardous materials covered this manifest exceptas noted in Item 19. <br /> T Prinhrd/Typed Name 5igmture Month Day Year <br /> Lrvr �Yc rT g 49a 7 <br /> DO NOT WRITE BELOW THIS LINE. <br /> ++ DTSC 8022A (1/95) Green: TRANSPORTER RETAINS <br /> EPA 8700-22 , <br /> 1 _ <br />