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State of California—Environmental Protection Agency41.r' <br /> .5." 1 <br /> a <br /> „Form Approvo OMB No.2050-0039(Expires 9-30.99) See Instructions 011 bac�C Of 6. Department of Toxic Substances Control <br /> r&-%se print or type. Form designed for use on elite(72-pitch) . Sacramento,California <br /> L' 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS C+ ' s 64 01 74 f is not required by Federal law. <br /> WASTE MANIFEST of <br /> yy3,pqGeng,e»rr,ator's Name CanRd MaiyI' Address A. State Manifest Document Number <br /> 1�A2T iur �i'"4 T0 20375,457 <br /> L OD I CA 95240-4799 B. State Generator's ID <br /> A. Generator's Phone( 0 ) 333-3500N r~ <br /> -. <br /> 5. Transporter 1 Company Name 6. US EPA ID Number s' C. State Transporter's ID[Reserved.] <br /> LO <br /> SAFETY—KLEEN SYSTEMS, INC SCRO0007 � D. Transporter's Phone 900 669-15740 <br /> O <br /> C? 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporters ID]Reserved.] <br /> —1 f. Transporter's Phone <br /> V 9. Desi noted Facility Name and 35ite ddress 10. US EPA ID Number G. StatetFaa I IQ r A t <br /> � ,F�`TY--KLaEVN SYSTEMS, s s-", `��a+` <br /> Z !:-750 SALIDA BLUD <br /> a r. 9 5^-i e CATOOOtI3965H. Facility's Phone <br /> Q 12. Containers 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> No. I Type Quantity Wt/Vol I. Waste Number <br /> �4N i a WASTE COMBUSTIBLE L I U D, N. O. S. DM G State '74 1 <br /> ` <br /> (PETROLEUM NAPHTHA) NA1993 P0111 � � � � � t? EPA/Other <br /> G D�30I <br /> cER0#128)6. 7#/QA�L (000.4 . 1>01 , , D040� C1 <br /> oN 6 . state 741 <br /> S- <br /> 00 E WASTE CION! VSTI E LIGUID, ISI, O] tea. <br /> (PETROLEUM NAtPHTH� ) t9tA199`3 POIII RG DM EPA/Other <br /> v A <DOO I)ER G#128 ( . 7#/OL.> (D018, 3'4, 0) z 8 ( I. 0 DOO I <br /> O T C. State <br /> op O <br /> R EPA/Other' <br /> L <br /> State <br /> LU <br /> d' <br /> Z <br /> w EPA/Other <br /> V J <br /> J. Additional escrip ons for at ials Liste Abov K. Handling Codes for Wastes Listed Above <br /> Oi D + 3 040 <br /> LU <br /> ` I C I 03 0 a. 1,4 b. <br /> oc d. <br /> Z 5 I nst o s n t nal F r ono <br /> 760 24HRQ <br /> LU <br /> A 704 B eoi c D <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,packed, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> V <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 economically <br /> C- practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> rn and the environment;OR,if I am a small quantity generator,1 have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> O <br /> >- PrinterTyped Name Signature , Month Day Year <br /> w RT 17. Transporter 1 AcknowledgementdfReceipt of Materials <br /> w A Printed/Typed7111� pNome Signatur gMonth Day Year <br /> N "I <br /> LU <br /> LL- 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed ed Name Si nature Month Day Year <br /> T yp g <br /> LU E <br /> N R <br /> Q <br /> O 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> L <br /> 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />