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State of California—Environmental Protection Agency t <br /> Form Approved OMR No 2050-0039(Expires 9 30 99) See Instructions on back of Page 6 Department of Toxic Substances Control <br /> Pill se prml or type Form designed for use an elrre f12 pitch)fypewrrter Sacramento California <br /> UNIFORM HAZARDOUS 1 Generator's US EPA ID No Manifest Document No 2 Page 1 Information in the shaded areas <br /> is not required by Federal Saw <br /> WASTE MANIFEST of <br /> 3 Generator's Name and Maiiing Addressfil mliil 11151 1 <br /> LO <br /> i <br /> LO 4 GeneT6tor shone I } <br /> i N 5 Transporter 1 Company Name 6 US EPA ID NumberLn <br /> rr <br /> WORM EVRONIA MSMICES <br /> DAD982 � 13252 111 1: <br /> 00 <br /> 7 Transporter 2 Company Name 8 US EPA 10 Number <br /> I J ' <br /> Q <br /> V 9 Designated Facility Name and Site Address 10 US EPA 10 Numbers <br /> VOGREEN OIL,INC. <br /> 690 Sm th AV~3ttus <br /> 1 JKPIRA CA 94%0 19 1 A 10 1 US 101817141118 <br /> Q 12 Comamers 13 Total 14 Unit <br /> 11 US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> No Type Quantity Wt/Vol <br /> a <br /> 0% ' �OkUID <br /> yap <br /> E 01011 T T <br /> b 51gftm 4 <br />! coco E <br /> t Q R <br /> CN A c Sia <br /> t o T <br /> I 0 O <br /> 1 R "EP { <br /> I <br /> uj <br /> d Sro't <br /> Z <br /> LU y •.e <br /> i ' <br /> 7a pt " t&f �a ' <br /> CL <br /> aC 4 <br /> 0 15 Special Handling Instructions and Additional Information <br /> 24 Hour Enemy Rapm Ye4hone Noy CKUMEC 14"4-M IMICe WF Z 41773 <br /> LU <br /> ERO 171 WEAR PROT�IE MUIPMEff Sass Order! <br /> 16 GENERATOR S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed <br /> Vmarked and labeled and are in all respects in proper condition for transport by highway according to applicable international and national government regulations <br /> If I am a large quantity generator I certify that I have a prog9ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> a practicable and that I have selected the practicable method of treatment storage or disposal currently available to me which minimizes the present and future threat to human health <br /> j and the environment OR if I am a smaquantity generator I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> Oavailable to me and that I can afford <br /> 'y Printed/Typed Name Signature � Month Day Year <br /> V �� 9fts�! <br /> Z <br /> A 4A1110 <br /> 0 T E Tronsaorter Acknowled ement of Recei i of Materials <br /> NPrinted/Typed ome a Signature a Month Day Year <br /> W <br /> luj P <br />' is_ 0 18 Trans artar Acknowlodgement of Recei pt of Matenals <br /> O T Printed/Typed Name Signature Month Day Year <br /> us E <br /> Vi p <br /> a <br /> t,) F 19 Discrepancy Indication Space <br /> Z A <br /> i <br /> C <br /> fC <br /> L <br /> f 20 Faciliiiv Owner or O erator Certification of receicit of hazardous materials covered bX this manifest exce t as noted m Item 19 <br /> T Printed/Typed Name Signature j Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE <br /> DISC 8022A (4/97) r <br /> EPA 8700-22 Yellow GENERATOR RETAINS t <br />