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State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back of page 6. <br />III Please print or type. Form designed for use on elite (12-pitcP'rif r.$ 5- 0 1 <br />b <br />C11 <br />C <br />cc <br />ac <br />c <br />c <br />a <br />LL <br />2 <br />LL <br />L <br />LL <br />V. <br />2 <br />C <br />V. <br />LL <br />C <br />2 <br />C <br />F- <br />a <br />2 <br />LL <br />v <br />Q <br />C <br />L <br />u <br />L <br />0 <br />LL <br />LL <br />Det2fmeint of�T�Pxic Substances Conhol <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (4/97) <br />EPA 8700-22 White: TSDF RETAINS <br />UNIFORM HAZARDOUS 3enerator's US EP No <br />Manifest Documen 1 <br />Information in the shaded areass <br />MANIFEST D 98 3 7 3 4 <br />t :joge <br />not required by Federal law.WASTE <br />t - 1 <br />3. Cdanerator's Name and Mailing Address <br />MOTOR GUARD CORP <br />A. State ani festDocument Number <br />580 GARNEGIE <br />AN.TFXA Phane ( 1 CA 95336 <br />a. Stare Generator's 10 <br />^ , <br />2 3 9 9191 <br />5. Transporter 1 Company ate 6. US EPA ID Number <br />C. State Transporter's ID <br />w;j,F�yJ�g <br />D. Transporter', Phone <br />'. <br />SAFETY-KLEEN CORP. L 9 4 8 0 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID'800_ <br />__4`W-.•+'- <br />!"j <br />o yafrWii;;:- <br />F. Transporter's Phone <br />t44, grid;;." -;w. <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />fir-.. .... <br />-s.. <br />000636 <br />g <br />4 <br />SAFETY-KLEEN CORP. <br />H. Facility's Phone <br />x n` <br />1000 SOUTH I STREET 51918P <br />I �Ap 10?1 <br />e - r <br />11 . US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />2. Containers <br />13. To to l <br />T t <br />1 U nit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste�- <br />a. <br />State <br />HAZARDOUS WASTE, LIQUID, N. O. S. <br />EPA/o e <br />C <br />E <br />9QNA3082 PG III��DOWD039)(ERG#171) <br />DM� <br />�. <br />N <br />aSMte <br />E <br />EPA/Other <br />R <br />A <br />T <br />C. <br />Scare <br />O <br />_. <br />EPA/Other <br />R <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />a <br />b <br />IA) D039 <br />14 01 <br />C. <br />d. <br />15. Special Handling Instructions and Additional Information <br />MFST <br />R/T# 93905405 7-185-01-1540 <br />EMERGENCY RESP 800-468-1760(24 HR). IF <br />UNDELIVERABLE RETURN <br />TO GENERATOR. <br />K CORP AUTHORIZED TO RETAIN LICENSED <br />SUBSEQUENT CARRIERS AS <br />NECESSARY. <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the co nsi rnent ar, <br />ccu Ar, described above by aper shipping name and" classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport y highway <br />according to applicable international and national government <br />regulations. <br />If I am a large quantity generator, certify that have a program in place to reduce the volume and toxicity of waste generated to the degree I have <br />determined to be economicall y <br />practicable and that I have selected the rracticable method of treatment, storage, or disposal <br />currently available to me which minimizes the present <br />and future threat to human health <br />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 <br />available to me and that I can afford. <br />Printed/Tysed Name Signature <br />-++r'� <br />Month Day Year <br />_ <br />A17. <br />Trans orter 1 Acknaw a emenf of Receipt of Materials - <br />A <br />Prin Typed Name <br />YP <br />Signotµterd, <br />�„�+' <br />Month Day Year <br />ItP <br />_ <br />0 <br />18. Trans orter 2 Acknowledgement of Receipt of Materials <br />"'---�.�✓^ <br />A <br />T <br />Printed/Typed ed Name <br />Yp <br />Signature <br />Month Day Year <br />E <br />A <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Faci . Owner or Operator Certification of receipt of hazardous materials covered by this manifest,exce t as noted in Item1 9, <br />Y <br />Prince r�pe<i e �" - <br />Signature <br />/; 11 <br />M nth Days_ Year� <br />,(/� <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (4/97) <br />EPA 8700-22 White: TSDF RETAINS <br />