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State of.<talifornia—Environmental Protection Agency _ry -`"8 5 t Form-,4pproved OMB No.2050-0039(Expires 9.3Q-99) See Instructions on boil O a 6. Department of Toxic Substances Control Pfjp4se print or type. Form designed for use on elite f 12-pitchwriter. Sacramento,California UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas WASTE MANIFEST 13 ' �° is not required by Federal law. of )3� ��pgrat 'sr2 rQr (�A� ss ry�' A. State Manifest Document Number L.:0.;I I A 95240-4799 2404799 & State Generator's ID WA. Generator's Phone l209) 333-3500 CV S. Transporter I Company Name 6. US EPA ID Number G. State Transporter's tQ[Reserved,] tfeeb "i Z°^ itwSYSTEMS, .�Ikfa,. ;�C0000751'50 D. Transporter's Phone L 800 6,69-5740 o? 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] F. Transporter's Phone U U ti[1e dle r :ti. 10. US EPA ID Number G. State k tt �� t A.r _'k`1. b ^, Z ; F'.;� f ,P:, f. .. ;. ...Vis, .1•.: a: F::? f .,; H. Facility's Phone O w :#qty Q12. Containers 13. Total 14. Unit U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No, Type Quantity Wt/Vol I. Waste Number ® Z= 14ASTE COMBUSTIBLE LIQUID, N. 0. S. DM 01 Stare 741 (PI~TROL.,EUM .NAPHITHA) NAI?9:3 PQIII -fig 3: G 4 ERG 120 3 6. ,#/teak_ (D001, D018, 1-}�393 £3040) 3 :.>C} '• J EfrA/Other }d ; E N 6. State o N WASTE COMBUSTIBLE LIQUID, IN, 0. S. 41 o f f FEl•'RLtLEUM NAPHTHA) NA199 3 r G 1 I I ISG �i'°'! •'1 G N R f,�s€3i�'I. I ER G 128 C 6. 7 :' L.) t r-018 r .C,0 39� I�040) .c EPa/oth®r P00,-1 V A O j C. State ao o EPA/Other R o: F d. State Z LU V EPA/Other' d. Adrli icmgl sc�ripfiong,f�M rials Lfstgd 460 ,. K. Handling Codes For Wastes Listed Above x r"� 41 #a da wS a k fi1 r dJ,l,°°4 Q N I (B) Dole Do"39' AO- 1 b.L4 Uj c. d. nf stipl s �QT:PdP"""'i't '" .Snt."� ` O .. .,. a4 0 71 H Q Z w A 704 B 80i Iro t- 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, Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. 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 1 have determined to be economically practicable and that I have selected the practicable method of treatment,storage,or disposdl currently available to me which minimizes the present and future threat to human health N and the environment;OR,if I am a small quantity generator,I have made a good fait`effort to minimize m�•waste generation and select the best waste management method that is Oavailable to me and that I can afford. " Y Prints yp Name Signature PMonth Day Year w T 17. Transporter 1 Acknowled /men,'of Receipt of Materials oUj C p P int'4d/Typed Name ,i�{ Signa e t r �/ Month DayYear `2 5 w U- 0 18. Transporter 2 Acknowledgement of Receipt of Materials O RPrinted/T ed Name Signature Month Da T YP 9 Y Year w E- rn R U 19. Discrepancy Indication Space Z F A _ C L 20. Fac 'y Ow er Operator Certification of receipt of hazardous materials covered b t is manifest exce t as noted in Item 19. In Printed/Typed ams , Signature ) f t on Day,,_ Year DO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 8022A (1/99) (Generators who submit hazardous waste for transport out-of-state, EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)