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State tA' —.Environmental Protection Agency nC_ <br /> Form Approse,.0 B No.2050--0039(Expires 9-30-96) -0 S@@ Instructions on back of ) 6. <br /> Department Toxic Substances Control <br /> Please •.... type. form designed for um on slits 112-pitch)lyp ,.ror. Sacramento,California <br /> UNIFORM HAZARDOUS ��,, �5s <br /> No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST 2 9 7" - 1 ' of 1 is not required by Federal law. <br /> 3. Generator's Name and Mailing Address iANBORN CHEVROLET <br /> 1210 5 CHEROKEE <br /> W) 1 <br /> IP <br /> CA A ti 5240-5994 B. State <br /> Le)N Q <br /> OD 4. Generator's Phone 01h) 334 500(, <br /> 5. Transporter 1 Company Name 6. US EPA ID Number tahl Transporter t,ID yi <br /> 0o r; r —1,I.t E Fit L Ci- F LP 994908"?02 �, q <br /> rauporter s Phon¢:r <br /> Q7. Transporter 2 Company Name 8. US EPA ID Number Transporter's ID <br /> U .s. <br /> H Q Tronsporier's Phone 5 <br /> 9. Des noted Facili Name d Address r Y 10. U$EPA ID Number S}a Fa I J <br /> ,V x <br /> C- <br /> 0 <br /> ��C7S' F , <br /> )50 <br /> ,rlA, C 9".468 CAT 000613968 H. Faciliy's Phone" <br /> A Z 11. US DOT Description Containers 13. Total 14. Unit <br /> (including Proper ipping Nome,Hazard Class,and ID Number) No. Type Quantity Wt/Vol <br /> n ~ .lAST DOMPOVNDr CLEANING LIQUIDDM G <br /> 3 G .'1 ' ".L 3 ;;AI-760 PGI I I (DO06) Other` <br /> o E ` i'v%3. L$) � 0027D-O q'E': -4'0) t F RGIW 154) i 9#/GL <br /> N C117i 4 ` <br /> v <br /> E <br /> C'4 R ' /Other <br /> A <br /> T C. State <br /> O <br /> o, R EPA/Other - <br /> w <br /> Z d. State <br /> V <br /> LU EPA/Other <br /> N <br /> Z J Addi <br /> O p , If,HtxtdUnp Codes for Wastes Above <br /> FIT <br /> , s� L� ; <br /> V) i s�" �a ire $ * : `x a;; f . r • ..�i #, <br /> LU t <br /> C. <br /> Q <br /> Z -: <br /> O 15. S ial Handfing Instructions and Additio6al Info `i <br /> Q ""^ZHGENCYY REQ. Pit900— *sl,; b0 24HR <br /> Z ) <br /> LU A: 950 B, C' D: 1 <br /> t— � <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, <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 /> CL 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 health 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 /> waste management method that is$available to me and that I can afford. <br /> O Printecl�jyped Name Signature Month �Dylc, ea <br /> U <br /> w g 17. Transporter I Acknowledgement of Recei of Materials 1 <br /> (� A Printed/Typed Name SignatureN X7 ,,.,',�.. MoY <br /> e tl <br /> LLJ <br /> i I 1/ •s ,,'h '''iJ 1 I j <br /> u.l 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> LL T Printed/Typed Name Signature Month Day Year <br /> O R <br /> N19. Discrepancy Indication Space <br /> U F 1 <br /> 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 1 <br /> v <br /> DO NOT WRITE BELOW THIS LINE. <br /> / <br /> DTSC 8022A (1/95) Yellow: GENERATOR RETAINS <br /> _, EPA 8700-22 <br /> I <br /> r <br />