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State of California—Envirenlpl Protection Agency <br />Form Approved OM67�q 05 J9 (Expires 9.30 991 cJ@@ Ef15ICUCIlOf15 Oft bOC�C O C 6. Department of Toxic Substances Con <br />Please print or type. form designed for use on el+P4tj1 h it Sacramento. California <br />0 <br />04 <br />h <br />0 <br />0 <br />co <br />j <br />�0 <br />�Q <br />TU <br />MI <br />(V <br />O <br />010 <br />if <br />(V <br />d <br />0 <br />m <br />cX <br />LUt- <br />Z <br />W <br />U <br />LL <br />VI <br />Z <br />tr. <br />LL <br />ar <br />Q <br />z <br />C <br />i� <br />a <br />z <br />LL <br />x <br />d <br />L <br />v <br />cisC <br />T <br />2 <br />LL <br />C'. <br />as <br />LLLL <br />u <br />C <br />1 <br />DTSC 8022A (1/991 jello -w GFNI k�,�;.-v <br />EPA 8700•--22 <br />ARDO <br />uNOF®RNi HAZARDOUS <br />H <br />I . Generator's US EPA ID No. Manifest Document No. <br />2. Page I <br />Information in the shaded areas <br />WASTE' A <br />_ <br />�,�IT,,.,�1 .,� F,, 4�t,1�, �1 Gl , 5 <br />of <br />is not required by Federal low <br />3. Generator's Name and Moiling Address <br />A`s;Stote Manifest Document Number r <br />DART CONTAINER <br />3 <br />1400 E. VICTOR ROAD, WD.1, CA 95240 <br />B. State Generator's ID <br />I R <br />A. Generator's Phone (z0,Q333- 80£5 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. 5tote Tronsporter's ID lResemed.1 <br />RAMS ENVIR014MENTAL SERVICES C1 JA J) 10 14 14 10 10 1115 <br />15 16 <br />D Transporter's Phone 916) 371-5747 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID {Reserved. J <br />F. Transporter's Phone <br />9. Qgajptta9 `d.�i ee Address 10. US EPA ID Number <br />G. State Facility's ID <br />[Y Y 1nV YLrF <br />3650 EAST 26TH STPEET , VERNON, uAL <br />A 9002p, <br />H Facility's Phone <br />C 1A IT 10, A 10 10 131316 <br />18 11 <br />(323) 265-5056 <br />TT <br />11 U5 DOT Description (including Proper Shipping Name, Hazard Class, and ID Numhti3') <br />12. Containers <br />13. Total <br />Id. UnitNo. <br />Type <br />quantity <br />WI/Vol <br />t. Waste Number <br />a KIN—RCFA rSAZA:14,is WASTEsCJi <br />State <br />3 52 <br />C <br />Oily solids`, FR, t00 i11ri <br />� <br />: <br />heEPA/C r <br />NIA <br />E <br />b. <br />State <br />E <br />R <br />EPA/Other <br />A <br />T <br />c. <br />State <br />Q <br />R <br />EPA/Other <br />d <br />State <br />EPA/Other <br />J. Additional Doscrip�Iiy7tyfor Materials listed Above <br />K. Handling Codes for Wastes <br />Listed Above <br />11a."J 4 <br />a <br />b. <br />C, <br />d. <br />;✓� f t C.. <br />.J �J I I .!"SLS Y�t ` <br />15. Special Handling Instructions and Additional Information <br />HANDLERS TO BE TRAINED AND EJSF. Pel?. <br />24HR EMERGENCY CONTACT: 916—''71-5747 <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 ore classified, packed, <br />marked, and labeled, and ore in all respects in proper condition for transport by highway according to applicable international and notional government regulations. <br />If I am a large quantity generator, I certify that I hove a program in place to reduce the volume end <br />toxicity of waste generated to the degree I hove determined to be economically <br />practicable and that I hove selected the procticoble method of treatment, storage, or dispos culrently ovoilable to me which minimizes the present and future threat to human health <br />and the environment; OR, if I am a smolt quantity generator, I have made o good faith of rt 16 minimize my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />Printed/Typed a <br />Signotvrey ' j <br />Month Day Year <br />T <br />17_ Transporter 1 AcknowgJpementaf Receipt of Materials _ <br />A <br />Printed/Typed Narag �' ...__._ <br />TSignature : _ <br />Month Day. Year <br />0 <br />18. Trans rter 2 Acknowledgement of Receipt of Materials <br />TPrinted/Typed <br />Noma <br />Signature t <br />Month Day Year <br />f <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />Facility Owner or 2geralor Certification of recei 1 of hazardous materials covered by this manifest except as noted in Item 19. <br />'20 <br />T <br />Printed/Typed Name <br />Signature <br />Month Doy Year <br />Y <br />--- — --- - - ----- <br />-- - -- <br />_. --- _ -.--- <br />- _ I _.t I <br />DTSC 8022A (1/991 jello -w GFNI k�,�;.-v <br />EPA 8700•--22 <br />