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Jlifornio—Environmental Protection Agency 7--18 5—0, <br /> moved OMB No:2050-0039( xpires 9.30-99) See Instructions on back Of p 8 6. Depar ent of Toxic Substances Control <br /> * hint or type. Foom designed fo,use on elite(12 pitch)y r. acramento,California <br /> L <br /> rotor's US EPA ID No. Manifest Document No. 2. Page 1 Informati in in the shaded areas <br /> UNIFORM HAZARDOUS �.JAD07•�fa�&•�.901 80011.9 cf is not req fired by Federal law. <br /> WASTE MANIFEST <br /> . Generator's Name <br /> an�ailin Address i <br /> r€ i A.F State Manafes#4}ocurn Number � <br /> LOD ICA 95205 ,S rat rtt l# <br /> 4. Generator's Phone( 209 333-3500 <br /> N <br /> S. Transporter 1 Company Name 6. US EPA ID Number C'"mSTate Tiastsftarfes } eserye I <br /> h w xs <br /> ao <br /> oSAFETY—KLEEN 'Y �dSTEMS INC. SCRO00075I f�., IraaspartarsPfte�te <br /> X00 O. <br /> 0 <br /> T 7. Transporter 2 Company Name 8. US EPA ID Number StateTmsjsFortet s+Ff) served} <br /> F. Transportgr`s,Phone' � <br /> V Des'gn ed.F c7j e;Qnd it Aa r. s r 10. US EPA ID Number G. Stote Facility's ID <br /> 13 LIT 1.NQ <br /> Q °'_-`0C, "'1°-IEs4ff ON' ti1A'1 <br /> (; ":..n `' s H. Facility's Phone <br /> O Soo 1309-5625 . <br /> 12. Containers 13. Total 14. Uni <br /> ` Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> V No. Type Quantity Wt/Vol I: Waste Number <br /> State <br /> �..• <br /> .,.1�SDCJT REGULATED) a <br /> 3 G EPA/Other'" <br /> i <br /> o N b• 'State <br /> 6 E <br /> A/Otft® <br /> R EP <br /> A C. Sfate <br /> o T <br /> 0 ® EPA/Other•;a <br /> R <br /> Uj Z d. Strfte <br /> w t <br /> V � "EPA/Qfher � r <br /> LU <br /> 1::Addltionat Descrrptron for Materials Listed,Abave ffandliag;Codes for.Wasteslfsted A e <br /> c Q b <br /> uj <br /> � R <br /> Q. - °� '+w .: r ' A .�, °'Y �u W51 '.i _ Via. ` ti. • <br /> Z sir a s al 1 f r do _ s s°'4 Vi <br /> 0 '1 � �5'—�'$ t --� ;`fir° 24HR � <br /> Z SK AUTHORIZED TO RETAIN L.ICEN ED' SUBSEQUENT CARRIER, AS N.EC.---SSA"gY. <br /> W A 11249 E t.: <br /> t— <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 a e 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 /> —Js 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 deter fined ro be economically <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and futu�e threat to human health <br /> N and the environment;OR,if I am a smaquantity generator,I have made a good fait gffort to minimize my waste generation and select the best waste in nagement method that is <br /> �-' available to me and that I can afford. <br /> 0 ' <br /> } <br /> Print e Typed Name Signotur M nth Day Year f <br /> V ' <br /> LU T 17. raps orter 1 Acknowl ement of Recei of Materials " <br /> U R <br /> Uj q Printed T ped N e Signature f� Month Day Year <br /> ___.__ <br /> W 0 18. Trans ce t of Materials <br /> T Printed/Typed Name Signature Mc nth Day Year <br /> Uri E <br /> to R <br /> U F 19. Discrepancy Indication Space <br /> Z A <br /> C 4 <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Painted/Typed Name Signature M nth Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> •:r <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN!30 DAYS. <br /> ` DISC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 <br /> produce completed copy of this copy and send to DTSC within 30 days.) <br />