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/ t <br /> nvironmental Protection Agency _ <br /> e No.2056-0039(Expires 9-3096) " See Instructions on back of - 6. Department of Toxic Substances Control <br /> ape. Form designed for use on elite(12-pitch)tyF -r. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> 1 is not required b Federal law. <br /> WASTE MANIFEST I? OS 54�;d 9 7E,�'�12 q y <br /> of <br /> 3. Generator's Name and Mailing Add A. 5taps.MrsM*a Documerd <br /> SANBflRN CHEVROLET <br /> 1�I 0 S CHERQKI:E L ; <br /> B. State Gets i lD: ei y 4 M y c ri <br /> N !.r'3D' CA 95240-5994 <br /> sr1 4. �ienerotor's Phone <br /> 00 -69 3-14 5000 <br /> 5. Transporter 1 Company Nome 6. US EPA ID Number C. StaM.Tnonsparhis/ID ` "< <br /> 00 <br /> SAFETY—KLL N CORE L 9 4 G G D, Trasport.,',,Phone. <br /> J <br /> Q7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporler's ID <br /> U <br /> F. Transporter','Phone <br /> Z 9. Designated Facility Name and Site Address 000636. 10. US EPA ID Number G. State Facility's ID <br /> W SAFETY-KLEEN CORP. �} q <br /> ,0 1COQ SOUTH I STREET � <br /> REEDLEY, A 9:3654 A �7 3�, 9�Ei'S H.,FacilitysPhare <br /> �U <br /> 11. US DOT Description(including Proper Sh ,n Name,Hazard Class,and ID Number 12. Containers 13. Total 14. Unit <br /> Z P ( g P PP 9 ) No. Type Quantity Wt/Vol `l. Waste Number+ <br /> a.t II <br /> Stall <br /> 3 HAZARDOUS WASTE, LIQUID, N. 0, S. 9 OF G 14 <br /> G NA30132 PG I Ill (D039, 0006, D040) (ERG#171 i EPA/Other f - <br /> c` E c, 3�? <br /> CO N b. <br /> 4 E <br /> N R EPA/Other <br /> A <br /> co T c. State <br /> O <br /> R EPA/Other <br /> LU <br /> Z d. State <br /> Z <br /> LU <br /> U <br /> LU EPA/Other - <br /> N <br /> Z J.':AdditloNat Description;for Materiae* ed Above— K Handling Codas for Wastes Listed A6ovo <br /> t AN <br /> 'I DOCh <br /> Q m _ , <br /> Z <br /> O 15. Special Handling Instructions and Additional Information 9 '13 93249284 284 7th, •0, 1 —1 91t-0 1 1676 01 <br /> a EMERGENCY R ESP OSOO--468-1760 24HP <br /> z <br /> = C: 0: <br /> I , [ < ARU t c'. <br /> 16. GENERATOR'S CERTIFICATION: I here declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q packed,marked,and labeled,and are in 11 respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <br /> If I am a large quantity generator, I certi 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 /> J <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> N threat to human heal+ and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> W waste management method that is available to me and that I can afford. / <br /> O Printed/9P-er"1-'- <br /> erne Signatur Month ay Year <br /> r;. C <br /> Uf . ._ <br /> l I <br /> Z <br /> N 17. Trio1 Acknowle ement of Recei of aterials <br /> (� A Printed/Typed Name Signature J Month Day Year <br /> wN <br /> s _ <br /> P <br /> LU 0 '19. Tranz a ckn la ement Lf ecei t of AA&feriols <br /> LL T Printed/Typed Name Sigrwturs Month Day Year <br /> O E <br /> A <br /> N19. Discrepancy Indication Space <br /> Q F I <br /> U A <br /> Z C <br /> — I . <br /> E <br /> 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y + <br /> 1 � <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/95) Yellow: GENERATOR RETAINS S <br /> EPA 8706-22 <br />