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�+7" •+ haleauuaranca!controlUlvision !, <br /> Please print or type. (Form designed for use on alit@(12-pitch typewriter). and Front of Page 7 Sacramento,California <br /> UNIFORM HAZARDOUS f. .razor's US EPA ID No. Manifest Pager <br /> o m Information in the shaded areas <br /> WASTE MANIFEST C 0 7 � t tip. of isnot required by Federal law. <br /> i 3. Generator's Name and Mailing Addre¢s / A. State Manife t poc�ti^and Nhr_ <br /> f The Estate of Louse Graffigna, John Graffigna Execut x . 8 1 1 2u,"9"7 9 <br /> P. 0, Bax 3$8, Lodi , CA 95241-03$8 8. State Generators to <br /> d. Generator's Phone(209) 368-5361 - <br /> u) 5. Transporter t Company Name 8. US EPA 10 Number C. Stele Transporter' AD <br /> NOR CAL OIL C 9 1 7 <br /> N D- Transporter's Phone 0L332-$710 <br /> u1j' T. Transporter 2 Company Name a, US EPA ID Number _ E. Slate Transporter's'ID <br /> F. Transporter's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA it) Number G. State Facility's ID - <br /> REFINERIES SERVICE C A ID 0 18 3 11 16 6 7 12 18 <br />-�I 13331 North Hwy 33 C A D 0 8 3 1 6 6 7 2 E H. Facility's Phone <br />! Z Patterson , CA 95363 PAXOM800 874-4444. . <br /> Imo" i 12. Containers' 13. Total 14. I. <br /> O t f. US DOT Description(Including Proper Shipping Name.Hazard Class,and 10 Numbet) quantity Unit Waal*No. <br /> - :No. Type Wt/vol <br />�Z HAZARDOUS WASTE KIA LIQUID state 223 <br /> hr i ORM-E NA-9189 EPA/Other <br /> N Q1C1 1 T I CiO01 12 G <br /> E b. <br /> c+i R State <br /> A <br /> T EPA/Other <br /> N 0 0 <br /> R c, <br /> o Stale � <br /> a <br />,33 <br /> .- •3 EPA/Others:- <br /> W d. <br /> Z Stat@: dip <br /> LU EPA/Other,:,`, <br /> U <br /> to <br /> Z J. Additional Descriptions for Materiels Listed Above K. Handling Code$for Wastes Listed Above <br /> a TANK BOTTOM WASTELU <br /> a. b. <br /> Cr RINSATE 4. <br /> J . 7 <br /> Z 1 <br /> 0 1 <br /> 15. Special Handling Instructions and Additional Information <br /> Z APPROPRIATE PROTECTIVE CLOTHING <br /> "EMERGENCY CONTACT: (800) 332--8710" <br /> SEE E.R.G. 31 <br /> G 1e. <br /> 0 <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described ebove'by proper shipping name <br />? ' <br /> and are classified,packed,marked,and labeled,and are in all respects in proper condition Tor transport by highway according to applicable internatlonat and <br /> national government regulations. <br /> if I am a large quantity generator.'I certify that t have a program in place to reduce the volume end toxicity of waste generated to the degree I fisve determined <br /> 0 r to be economicaily practicable and that t have selected the practicable method of treatment, storage•or disposal currently available to me which minimizes the <br /> present and future threat to human health and the environment;QR,if I am a smelt quantity generator,I have made a good faith effort to minimize my waste <br /> generation and select the best waste management method that is available to ine and that art afford <br /> Z <br /> lu Printed/Typed Name Signature Month Day Year <br />� . <br /> W MARTIN THORPE 31 <br /> 08T293 <br /> u�lT IT. Transporter I Acknowledgement of Receipt of Materials II <br />< A Prfniad/Typed Name - - <br /> N Sign a Manfh Day Year <br /> LL <br /> D P 0 18 1263 <br />�,y O 18. Transporter 2 Acknowledgement of Receipt of Materialsf <br />¢ R Printed I Typed Name ig vie <br /> jAdorith Day Year <br /> z I E� • I <br /> 18. Discrepancy Indication Space <br /> A <br /> C . <br /> t r <br /> t 20. Facility owner or Operator Carlfficatl�n of receipt of hazardous materials covered by't ' IE a e>r noted e t <br /> T <br /> y PrintedlTyp ami <br /> Signature Month Day Year <br /> �. /�C.e �6Cf <br /> HS 8022 A(1188) C_- <br /> PA <br /> /O Not Write Ow- IS Line <br /> PA e�oo--xz Wh TSDF E THIS COPY TO DOHS WITHIN 30 DAYS <br /> tev.9-e8)Previous editions are obsolete. To: P.O. Box 3000, Socramento, CA 95812 <br /> _ b <br /> - - <br />