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<br /> 1, C-dismec✓e US EPA ID No. Manifest DOCUrnant Na, nr SoCiantenb, . T
<br /> T UNIFORM HAZARDOUS 2. Page I infarmmlon in the
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<br /> WASTE MANIFEST 0 0 4 a O 1 IF1072 of ,1' Is nut mqulmd by f dsiol
<br /> 3. Goneratotrs Name and Mailing Addreu
<br /> 1029 9 SACRAMENTO TE LAKE }► saatAanif asD�,,,,v,,N,n„�v.
<br /> h LOD I CA 95240-4799 s sro1.Ge"Kalor's ID ,
<br /> a. Go"rolors Phone(209) 333-3500
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<br /> S* Transporter 1 Company Name G..
<br /> OR
<br /> 6. US EPA ID Number C:Shan Ttvnapartels 10( •] -
<br /> SAFETY—KLEEN SYSTEMS, INC
<br /> R ® I 1 D. Traneponers Phone ,.,•: ..
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<br /> parrot 2 Company fVame 0. U5 EPA 10 Number E. Srtoe Trontporta/s IDIReservwa j— d1..
<br /> Transporter!Phone �yT�.�""
<br /> V 9. Doi noted Facility Name and Sin Address 41 ; '
<br /> Q BAF�TY— 10, US EPA 10 Number G. Shue Foci iy,ID ,
<br /> Z 5050 SALIDANBLVDTEM9, INC C T O i 968
<br /> p SALIDA, CA 95368 T OQ41 9�5Q N. r�lliys Phone .. - t
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<br /> I. US OOT Description(including P 12. Contaiwsrs 13. Total 1 e t 4dt �A
<br /> ( 9 raper Shipping Name,Mozord Class,and ID Number) I
<br /> Z a No. T Quanri wt.••I r l,.Woste
<br /> = WASTE COMBUSTIBLE LIQUID, N. 0. S. J DM A
<br /> a (PETROLEUM NAPHTHA) NA1993 PGiII
<br /> � G (ERG#128)6. 7N/GAL (D001, DOHS, D039, D040)
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<br /> o N b• WASTE COMBUSTIBLE LI®UID, N. O. S.
<br /> a' E (PETROLEUM NAPHTHA) NA1993 POIII R® DM µ.ms
<br /> A (DOO1 )ERQ#128 (b. 7#/GL) ( 018, D039- 12940) 4 EPA/ '
<br /> T C. +ll001
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<br /> Store "e 77'i
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<br /> 1, Additional Daaeriptiure for,.IOlerial'Uated Abo.s -•
<br /> I(A) D018 D039 ; (A) D040 K. Handling Cod„For wosrot ti,rod At.un
<br /> g I(8) D019 D039 B) ,
<br /> IOU D040 k' ® iq )b1.
<br /> �'ji ,,Fit-'•,. �P''. .�_'�`L y.L�.�.�}r y•`Q s ih ..�;r .,e ti '-`!1.,d¢sa . �' %e, y.Y,`z':y`' y :� -t lax i� �' �tyti ar
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<br /> Zis. of Handlln Instructions and Additional Information ,...
<br /> Inii 0EM GENC� RESPOeOO-468-1760 24HR 9- 1020251007130 2 0402415397 Oq
<br /> Z A 704 B 801 C
<br /> 16. GENERATOR'S CA1l/1t1CATlom. I hereby declare that the contents of this cons( nment are hdl and accurately described a"b pi
<br /> V marked,and labeled,and are in all nespach in proper cand;l=far Iransport�hi®h..ay aeyeardiwg to opplicoble inMnmionol and n�airowal gwernmenr regulorianstr�
<br /> If 1 am a large gaanN generator,I atrtify that I haw a Program in place to reduce the taiume and toxicity of`+oats
<br /> d 7 gerre•orsd to rhe degree I lwve derorm,nsl to be amnomicolty
<br /> practicable and that I bars selecrad the procticable method of treatment,atorage,or di currendr aroilahle to me%risich minimizes this present and future threat to human health
<br /> and the envirammenti OR if 1 am a'mall quantity generator,I have mach a good folds to minimise my wars generation and elect the beat were manogemisar mnhw mat a
<br /> available to me and star i can afford.
<br /> Prin
<br /> It"hypej Name S(®nanrn Monrh Dar Year
<br /> > 17, Trans rver I ment f Recei t of materials
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<br /> % APrin Name Slgntuu
<br /> s < Month Dor Year
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<br /> d0 10, Trom rter 2 Acknowledgement of Regi of Material.
<br /> TPrtnted/Typed Name Signature month Dor Year
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<br /> V 19. Discrepancy Indlcartion Space
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<br /> I M. Fdcili Omar r Operator Cervi' 'on oaf roceipt of hazardous materials roared b th• seanife I stt at noted in Ilem 19.
<br /> 10 p Printed/Ty • Signature Y gna th .i I V► t«n
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<br /> DO NOT WRITE BELOW THIS LINE.
<br /> DT5C 8027A(1/991 vk ra: TSDF SENDS THIS C:?Y TO DTS' %'::TrtIN S: t
<br /> EPA 9700--72 'o, J.G. d:a :OGQ. Sauce,.nra 5 '12
<br /> 20 ' d 82S6666 01 0696 SbS 608 105612-715 bd 65 : 6i 2_ _
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