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State of Colifornio--Environmental Protection Agency <br /> Ftrm Appro OMB No.2050-0039(Expires 9-34 6) /—I a`� 01 S@ In tructions on back o e 6. <br /> PI p,intor type, form designed for use on sl' (12pitchJ IypewriMr. 9 D°PartmMt 01 xic Substances Control <br /> Sacramento,CaGforria <br /> UNIFORM HAZARDOU I. Generator's VS EPA ID No. Manifest Document No. 2. Page 1 Information in AT#shaded areas <br /> WASTE MANIFEST D 011 5 59 9 76 )41 of 1 is not required by Federal law. <br /> 3. Generator's Name and Mailing Add SANBORN CHEVROLET A Stat�l+kwfatpgsvment <br /> 40 1210 S CHEROKEE LN <br /> QQ CA 4 <br /> 95240-599 a stateG�neratorttp <br /> 4�GeDrZtor's Phone ( d9 234-5000 <br /> 5000 <br /> 4 <br /> 5. Transporter 1 Company Name b. US EPA ID Number C State Tro s 1,5 1 s <br /> t .t77"3'��r�"�" y i Y <br /> ae 4+t <br /> SAFETY—KLEEN COR L 9 49C O D. Transp,arte�tphonA <br /> J <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> N U E. State Trolssl>ortlfy ID y 9 s t yM i iS ti s+ <br /> F. Transporter's Phone <br /> CO Z 9. Designated Facility Name and Site Address 00063-6 10. US EPA ID Number G. State Focility'YIO" <br /> V/� SAFETY—KLEEN CORP. ?9P15? <br /> 4 <br /> 1000 SOUTH I STREET <br /> �� REEDLEY, CA 93654 A 0 3459485 H, FaulrfysR <br /> M�q U — 410 <br /> 11. US DOT Description(includingPro hipping Name, Hazard Class,and ID Number 12. Containers 13. Total 14. Unit <br /> Cn Z p Proper PP g ) No. T Quantity Wt/Vol osto Number <br /> H a. e <br /> HAZARDOUS WA TE, i_113U I D, N. 0. S. 9 DF Q <br /> 3 G NA3082 PG III (D039,-D0O6, D040) (ERG#171 ) <br /> /ober. <br /> o E AGUEDUS BRAKE SOLUTION(S- s#/GAL) <br /> CO N b. <br /> 4 E <br /> CN R <br /> c� A <br /> ago T c. <br /> O <br /> R <br /> Lu <br /> Z d. ata' <br /> uj <br /> U <br /> Lu EPA/Other, <br /> Ln <br /> Z J Additional Des�cripyh�of,t,s tot <br /> C�� .Ati � K. Handling Cedes for Wastes listed flbove <br /> 0. <br /> IJj 01 <br /> 0 15. Special HandlingInstructions and Add" nal Information — <br /> EMERGENY RESP#800-468-1760 24HR <br /> Z <br /> �r <br /> LU A: 10086 8: 10, C: D <br /> C aCISARY <br /> J 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, <br /> J <br /> Upacked,marked,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 program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> J <br /> CL. economically practicable and that 1 have selected the practicable method of treatment, storage,or disposal currently available to me which minimizes the present and future <br /> V) threat to human health and the environment, OR, if I am a small quantity gene at I have made a good faith effort to minimize my waste generation and select the best <br /> Wte management method that is available to me and that I can afford. <br /> 0 rnted/wasTy Name Signatvr Month C Year <br /> U <br /> U <br /> WIt 17. Trio o er 1 Acknowle em tnt of Receipt of Materials ' <br /> () P Printed/Typed Name Signature Month Day Year <br /> W S <br /> t <br /> ty 0 19. Trans o er ckn I d ement of Receipt of Materials <br /> LL A Printed/Typed Name Signature Month Day Year <br /> 0 a I <br /> N19. Discrepancy Indication Space <br /> Q F <br /> U A <br /> Z C <br /> I <br /> L <br /> 1 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 /> DO NOT WRITE BELOW THS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (1/95) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-_22 produce completed copy of this copy and send to DTSC within 30 days.) <br />