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-- 7— .j Department of tox,c ,,u.Jdi. <br />tat"forma—Environmental Pro tion Agency See instructions on bOCIC Of Page 6. p Sacramento, California <br />oved OMB No. 2050-0039ExRires 9 30 991„, 2 Page 1 Information in the shaded areas <br />e or type',, Form designed For use on elite (12 -pitch) type- Manifest.Doculnent Na. <br />- �'i• is US EPA ID No. 'r- � - is not required bylederal law. <br />UNIFORM HAZARDOUS b of <br />b <br />WASTE MANIFEST A. State Manifest Document Number. <br />, <br />3. Generator's Name and Mailing Address <br />f - B. State Generator's ID <br />.8 REBUILDERS S7OCKTGN,CA 95206 <br />2325 W. CHART EI� WAY }, <br />In 4. I 4',)_ C. State Transporter's ID [Reserved.] <br />`n Generotor's.Phone F � 6. US EPA ID Number ' <br />tv <br />C145. Transporter 1 Company Name D. 7ransporter's Phone <br />g$�..e3e! ( ed: E. State Transporter's <br />O t e mer <br />O ompany phone 7- 'ranF- Tronsportez7 <br />- <br />J � �-t ✓ Y1 ✓ . G. State Fa—F <br />ID 3 Z <br />IQ 10. US EPA ID Number 0— <br />—i Q O I <br />}U 9. Desi �;: iiNO-KER D�n,�dONeAddress 1 <br />Q1 H. Facility's Phon3 j C) 537-1700 <br />)z 2Q00 N. ALAgE`DA ST `f <br />_O ICOf•PTONs CA 9©G 22 13. Total 14. Unit <br />12. Containers wt/vol I. Waste Number <br />L� No. Type Quantity <br />Hazard Class, and ID Number] State <br />%Q 11. USiOT Description (including Proper SkippingName, ..P.223._ <br />Z aNON 'RC.RA HAZARDOUS WASTE LIQUID EPA/otf0P1E <br />(OILY WASTE WATER) � 'D M <br />Stale _223 ,, i <br />G 1. G <br />04 <br />N bNON RCRA HAZARDf?(1S WASTE LIt2UtD EPA/otFONB <br />3 .Ln H O d I + <br />E ( BRAKE FLUID ). state t'. 223 <br />v R <br />C'44 <br />T `NON' FC HAZARDOUS WASTE LIQUID D' H Q <br />EPAIOVGN€ <br />O -'.(EMULSIFIED COATING SOLUTIION) State <br />R <br />a9 <br />�� pd EPA/Other <br />w ) <br />10 YAM MEAM HAS IM Q!lAtM N <br />z <br />U is FOR Listed <br />K. Handling Codes for Wastes Listed Above' <br />r l <br />LU P �a`°ifF'}CILITY — <br />cn �.dddtonal Descri ti 115, <br />1r�M <br />?T , ”` 6 I <br />j <br />�A ; <br />tl.OiINIA. t^ Tcrnm�a. d. <br />"I lms FACILITY HAS THC IsLt J ss�' <br />C. <br />Q <br />LU <br />STnF=a ASTO RECEIVE YOUASTE 6PRMlTS 200 3 2oaa- o <br />Z 15 Spea , Handling Instructions and Additional Information <br />0 �RIATE CLOTHING <br />zNCY RESPONSE — CHEM TEL, Z <br />2NC. 800-235-39L�� <br />w 4 HOUR EMERGE <br />_ yy P <br />t— I'icable international and national overnment regulations. <br />9 <br />—� _16.GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consign �?nh�Q according to described above by proper ship ,n9 name and are classified,pace <br />J b <br />Q <br />-marked, and labeled, and are in all respects in proper condition for transport y highway <br />U <br />g to minimize my waste generation and select the best waste management method that is <br />ticable method of treatment, storage, or disposal available to me which minimizes the present and future threat to human health <br />j IF I am a large quantity generator, I certify that I have a pro ram m place to reduce the voolume and toxicity of waste generated to the degree I have determined a a economicallymhealth <br />1 d practicable and that I have selected the pre generator, I have made a good faith effort <br />t N and the environment; OR, if I am a small quantity g Month Day Year <br />I ce available to me and that I can afford. 1 0 <br />O Sig to Q <br />i <br />r Pinted Typed Name <br />[ U Month Day Year <br />4c w teriols � O <br />{ T 17. Trans orter 1 Acknowled ement o ce, nature <br />fffCe Pr, ted/T edName �� f q, <br />w R .N16 G <br />S - !/' � Month. Day Year <br />LU P 7` ) <br />— p 18. Trans orter 2 Acknowled ement of cei 1 of Materials S,gnotu e r r C\ <br />O T Print T ed Name fc\ L ( j I <br />w E ` J <br />✓) R <br />Q 19. Discrepancy Indication Space <br />(1 TF <br />Z eA <br />_ C <br />[ t Month Day Year <br />L <br />f 20. Focilit Owner or O erator Certification of recei t of hazardous materials c nature b this manifest exce t as no in Item 1 <br />-T' Printed/Ty2VSWame �J <br />l , Y (J (J10 <br />DO NOT . WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />i. <br />/ (Generators who submit hazardous waste for transport out-of-state, <br />• • ' . produce completed copy of this copy and send. to DTSC within 30 days.] <br />MAR 13 2000 <br />