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}lifornia—Environmental Protection Agency" <br /> ved OMB No.2050-0039(Expires 9-30.99) See Instructions Ori back O e 6 Department of Toxic Substances Control <br /> f or type. Form designed for use on elite(12-pitch rifer. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generators US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> �'��'• WASTE MANIFEST <br /> 46 260 <br /> 5 of i is not required by Federal law. <br /> v� <br /> 3. Generator's Naft and Mailing Address INTERLAKE MATERIAL "ANDLIN A State Manifest document Number . <br /> 1029 S SACRAMENTO <br /> LODI CA 95240-47" B State Generators 1D E <br /> LO A. Generator's Phone(;! ) 3:333 3500 <br /> CN 5. Transporter 1 Company Name': 6. US EPA ID Number IC;.StateTranspartec'-a fD(Rase `e&00 <br /> } <br /> 0 reiFE Y''KE . E siD. Transparte(t hone 1 <br /> 00 7. Transporter 2 Company Name 8. US EPA ID Number E. State Tr`aasparfer`s:1A'Reset4ed.f <br /> 4d� I. <br /> a��psii J <br /> F. Transporter's Phone <br /> a <br /> V 9. Desi noted Facility me and Site r ss 10. US EPA ID Number G. State a li ' t <br /> 6000 88TH STREET <br /> 0:: SACRAMENTO CA X5828 CAOOOOO84517 H. Facility's Phone <br /> U- 416 6 4 3 <br /> (4J 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> No. Type Quantity Wt/Vol I. Waste Number <br /> USED CL..EANI O DS, N. 0, 1, 9. N. State <br /> G : LIQUID (NOT U$, T EP'A REGULATED) <br /> AQUEOUS PARTS WASHER SOLUTION (e. L) � � { <br /> O N b. state <br /> 0000 E <br /> v R EPAAOth`r. <br /> v A <br /> 6 T `' <br /> State <br /> R EpAlOthec <br /> LU d.;' State <br /> Z <br /> w <br /> V EPA/Other, <br /> f 1. Addition6fDescriptions far Ahaferiafs listed':Above K. Handling Codes'for'Wastes listed Above <br /> vt a 14 b <br /> LU <br /> ce E. . <br /> §fir <br /> Z 15. S e ial Handlin Instructions and Additional Information a� n <br /> !M'&?N? , RE OSOO�46a-1.x'60 6i4 <br /> z # ". , k ZED TO RETAIN- :LICENSED <br /> E ENT (CARRIER, AS NECESSARY. <br /> 941 8 C D <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper' <br /> hipping name and are classified,packed, <br /> Umarked,and labeled,and ore in all respects in proper condition for transport by highway according to applicable international and national government regulations. <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 /> a- practicable and that I have selected the practicable method of treatment,storage,���o,,,���r+++d,,,isposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have made a go tapth effort torn;nimize my waste generation and select the best waste management method that is <br /> O available to me and that I can afford. Or tr <br /> Printed ped Name 0y Signat re Month Day Year <br /> V <br /> w RT 17.:Ironsporter I Acknowledgement of Re t of Materials / <br /> W A ,Pint d/, ped Names yy ,1/ Signe Mont Do);.,; Year <br /> WP ` J '',�&d4 f u t,. f s•'r f, /l , <br /> O0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month .Day Year <br /> w E <br /> N R <br /> Q <br /> V 19. Discrepancy Indication Space <br /> F <br /> z A f Y� <br /> C <br /> L <br /> 1 20. Facility Owner or Operator Certification <br /> of receipt of hazardous materials co.er is ma Fest e s noted. Item 19. <br /> k(`Pfj��)teTl/T ped Name (f -��t 9n f e o <br /> a t ' ` "! P1 <br /> �✓ ocl�� <br /> DO OT WRITE LOW THIS INE. �./ M <br /> Yellow: TSDF SE THIS CO Y TO GENERATOR WITHIN 30 DAYS: <br /> DTSC 8022A(1/99) (Generators w o s mit hazardous waste for transport out-of-state, <br /> EPA 8700-22 s - produce completed copy of this copy and send to DTSC within 30 days.) <br /> + <br />