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°-3 See Instructions on back of a b. <br /> 9(Expires 9-30.96} �$ Deparhnerst of 7asie Submoscwe Cotard <br /> designed la use on CaG{onio <br /> 1. US EPA ID No. Manifest Docurrol No. ?_ Pape I Woneatiatj.do shaded aseat <br /> Ir- <br /> FORM HAZARDOUS a nut required by Federal krw. <br /> ASTE MANIFEST CAD 8 213141 0141 2 4 g b J' af. <br /> or's Name and Mailing Address A.'.SDo1r AAmrihsf:Doaurwrsfrl lwabr'- ".:. '�.;y~=:j:;��_x <br /> NELSON R <br /> P.O, BOX 29 t 2Q9 599-42Q5 P.RIPON CA 95366 a. *�» C�si4t_ .d >.•� •^ a��:. <br /> A. Gone General-r7 Ph * ' =r._ rgF "'�, '•: �r ;"''•'n ar' <br /> .��. -t � , ��F i.:, <br /> 5. Transporter 1 Company Name 6, US EPA ID Number CG:.SIGpw<.T - '• �. -.:•m^'�,'..+ ir'^; <br /> ALLIED PETROLEUM C I A I L 10 10 10 111112 13 1114 �. <br /> 7. Transporter 2 Company Name S. US EPA ID Number IY:St Tronspgrte s IDS. ,','1 -•3 <br /> ,F.'Ttottspomis3Phaw.. - -_ •'- - ��".'�5'''�' <br /> 4. Fq ill and d as 10 Number G. .. .. :'.: •...,, _...�. `"R <br /> 7. <br /> 13331 N HWYI 33 ff`.T�oCdld::aea � •.w _+„ <br /> PATTERSON CA 95363 C AE) 0 8 3 1 6 6 7 2 8 .4 +444+ ' ''_=}=` <br /> 11. US DOT Oescription(including Proper Shipping Name,Hazard Class,and 10 Number) <br /> 12. Containers 13. Tafel T 14. Unit r•`-:.::::;:r w s ='_w t;` l <br /> No. Type Quantity Wt/Vol 'T: Wasw <br /> J,_ <br /> '�`�-•. <br /> E EPA/.Ci@w.- (E <br /> A 1r <br /> O <br /> d. Stora <br /> EPA/pow. . <br /> J. A itional Descriptions For Materials listed Above K_ Hondting Codas Ear Wast t Usted'Above I� <br /> t.. b. I€�I <br /> PICK-UP <br /> f�,� r� -{-� r� I(1 <br /> 15- S ectal Handlin Ini"ctions and Additional Information PICK—UP AT ii34Q I�IiFrE 1 1 Rl1 a <br /> I;S� APPRQ-RTATE PROTECTIVE GEAR RIPON CA <br /> t7E5ISNATED FACILITY EMERGENCY CONTACT # 800-874-x.444 ' <br /> GC NERAROR EMPGNECY CONTACT # 209-599-4205 In <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment we Fully and accurately dmcribed above by proper shipping name and are classified, ��cel <br /> packn <br /> ed,marked.and labeled.and are in all respects in proper condition for transport by highway gv=fdirsq to applicable international and national government regulations_ U <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 datermined to be <br /> economically practicable and that I have selected the practicable method of storage,or disposal currently available to me which minimizes the present and future ., <br /> threat to human health and the environments OR, if I am a small quanttl. rator, h6ve ma a good! effort to minimize my waste generation and select the best <br /> -0$10 management method that is available to me and that I can afford. <br /> Printed/Typed Namp � Srg ore .. Day Year <br /> T I7. Trans orrer I Acknowledgment of 'ei t Of Materials /! is <br /> R <br /> A Printed/Typed Name Signature Day n <br /> i 5 f Yew <br /> ^ It f �'' G , � <br /> P <br /> O tf1. Transporter 2 Acknowledge no of Receipt of pteriph <br /> R Printed/Typed Name Signature Month Day Year <br /> T <br /> 1 q <br /> 10. Discrepancy Indication Space <br /> F <br /> A !f <br /> I <br /> I <br /> 3 I F20. Facility Owner or Operator Certification of recei t of hazardous materials covered this mor0rit oxcepras noted in hero r . + <br /> 7 Printed/Typed Namo r� Signature r Day Year 1I <br /> Y / I! <br /> b0 N >rWRITE BEL _ THIS LINE. ! <br />'SC 8W2A (9194) t <br /> A 8700-22 Green: TRANSPORTER RETAINS <br /> �I <br />