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I <br />e <br />Staeof alifornw—Enw nm nIGIPr edion gen� F <br />�Q ff y <br />Fo m Ap' ed OMB fJon"YQ� 0039 j ire% 9 3(}r 4) <br />Pldse paint type. , Fbrm de tjnedt�dr us ctd_elile2-pitc writer. <br />See Instructions on back c' -ie 6. <br />9 Department of Toxic Substances Control <br />v DO NOT WRITE _BELOW S LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DABS. <br />(Generators who submit hazardous waste for transport o6�of-state, <br />DTSC 8022A (4/97) produce completed copy of this copy and send .t L DYSCr within 30 days.) <br />EPA 8700-22 °c . <br />, r } <br />UNIFORM HAZARDOUS <br />generator's US EPA ID No. Manifest Document h_. <br />2. Page 1 <br />Information in the shaded areasu <br />WASTE MANIFEST <br />—, <br />is not required 6y a era law. <br />I 191 ol-Li o19� <br />of <br />1 .3. Generator's Name on�Moiling AddressA. <br />State Manifest Document Number <br />'QBR REBUILDE <br />96678384 <br />2325 W. CHATE�R AY, STOCKTON, CA 95206 <br />B. State Generator's iD <br />4. Generator's Phone ( 209) 4 7-0490 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. Slate Transporter's ID <br />D. Transporter's Phone <br />T <br />QS <br />1 — <br />_R <br />ransporter 2 ompany- ome ' 8. -US EPA 1D Number <br />F. Transporfer's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />ENSCO WEST, INC. <br />yy <br />.1737 EAST DENNI, WILMINGTON, CA M744 <br />IR <br />H. Fau ', Phone <br />9 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />13. Total <br />. <br />"W,11�.'I' <br />~ <br />I. Waste Number <br />No. <br />Type <br />NON—RCRA HAZARDOUS WASTE LIQUID <br />State 331, <br />G <br />(BUTYLE CELLUSOLVE, ALCOHOL). NAERG96#171 <br />D <br />r <br />EPA/Other <br />E <br />State <br />N <br />b <br />E <br />EPA/Other , <br />R <br />A <br />T <br />c. <br />State <br />0 <br />EPA/Other'' ' <br />R <br />d <br />Stale <br />-EPA/Other - <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />( / r <br />6. . <br />1 <br />56A L 7a,.�J`. S <br />C. <br />d <br />15. Special Handling Instructions and Additional Information �'�(( 3-7 y r 0 <br />H JII <br />HANDLERS BE 40 HOUR OSHA/SARA TRAINED <br />AND USE NIOSH APPROVED PPE. <br />EMERGENCY CMACT: (916) 371-5747 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurate)y described above by proper shipping name and are classified, packed,. <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and notiorwl government regulations. <br />If I am a large quant%y 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 economical)y <br />practicable and that I have selected the method of treatment, storage, or disposal currently available to me which minimizes the preseflt and Future threat to human health <br />practicable <br />and the environment; OR, if I am o small quantity generator, I hove made a good faith effort to minimize my waste generation and select the best Gwa6te.monagement method that is <br />' 'r <br />available to me and that I can afford. �� <br />Printed/Typed Name <br />Signa re ✓' <br />Month Day Year <br />7ale'CA ALP L <br />D <br />•R <br />17, PhAporter 1 Acknowled ement of Receipt of Materials <br />APrinted/Typed <br />Name ^ _ <br />gn ure <br />Month Day Year. <br />.S&- <br />/ L ,p rl <br />., (J� 1 7 4? <br />�� \ j 7 <br />0 <br />18. Transporter 2 Acknowled emenf of Recei t of Materials _. <br />R <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />- <br />L <br />I <br />20. FacilityOwner or Operator Certification of receipt of hazardous materials covered b this manifest except as note in Item 19. <br />T <br />Printed/Typed Name <br />Signature /` <br />Month Day Year <br />y <br />/ <br />_ <br />v DO NOT WRITE _BELOW S LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DABS. <br />(Generators who submit hazardous waste for transport o6�of-state, <br />DTSC 8022A (4/97) produce completed copy of this copy and send .t L DYSCr within 30 days.) <br />EPA 8700-22 °c . <br />, r } <br />