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State of California—Environmental Protection Agency —I —01 <br /> Form Approved OMB No.2050-0039(Expire 9-39-99) See Instructions on back of a 6. Department of Toxic Substances Control <br /> 11 se print or type. Form designed fbr use on elite(12-pitch) ler. Sacramento,California <br /> UNIFORM HAZARDOUS 1, Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> 70 1 26015 of <br /> Y is not required by Federal law. <br /> WASTE MANIFEST' <br /> . r <br /> 3. Generator's Name and Moilin Address A. Stote Manifest Document Number <br /> 1029 S SARANTO <br /> L ODI CA 95240"'4799 B State.GeneratoKslD <br /> 'n4. Generator's Phone( 1 -'^. 500 <br /> chi LO <br /> 5. Transporter 1 Company Name 6. US EPA ID Number -G. State TrtnsporteK s fD Reserved j } <br /> 77 <br /> o SAFETY—AL EEE YSTE:'V Int aC#�d�t'�{075150 D rtansporter s Phone <br /> D <br /> aD 7. Transporter 2 Company Name 8. US EPA ID Number E. Shite.Tionspatee s,I f ReserVd' <br /> QF_Transportees phone <br /> U A. Q fj�1?0 ty ffpand.$'t AINC10. US EPA ID Number G. State <br /> 4717 <br /> �Fw d' 1 <br /> 00 8TH STREET <br /> ad S_1,4 . n'.AME �'ro �^: 5 -9,8 C A0000094-51.7 <br /> H. Facility's Phone <br /> �—03"-49113 <br /> Q12. Containers 13. Total 14. Unit <br /> U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. I <br /> I Type Quantity Wt/Vol I. Waste Number <br /> Z a. State <br /> USEu C'L.- �aNlrlF a t$ss C f$f t, 3 . . y9 , i•„c <br /> s._IQVI (NOT USDOT OR U EPA REGULATED) <br /> PPAIbFheK l <br /> G AGU OUS PARTS WASHER SOLUTION «a 3#QAL) ".' � � � ,� a# <br /> o N b.co <br /> State F <br /> {n <br /> co <br /> E <br /> R EPAtQpher <br /> A C. state <br /> o T <br /> oo OR >PAlG7ttber <br /> LU d. State <br /> Z <br /> LU <br /> U E1sA/Other i u�, <br /> J_ Additional'Descriptions for Materials listed Above 1<4 Handling Cades bort Wdstes Listed Abitve <br /> a �, b <br /> 14 <br /> ¢ d.- s, 4- <br /> < i pi <br /> e�g�, . .: •, .,p� �1 - <br /> I I iia ns 3K e� 18e."'I��rpgatioi 760 4 � <br /> Z SX <br /> AU"6'HOR12ED TO RETAIN LICENSED T'B EOVENCARRIER, AS NECESSARY <br /> _ A 941 8 C O <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 /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> -J if I am a large quantiy 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 /> Npracticable and that I hove selected the practicable method of treatment,storage,of disposal 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 good faith effort to minimize my waste generation and select the best waste management method that is <br /> W available to me and that I can afford. a' <br /> }. Printed/ �ed Name.t ! Signat a Month Day,7 Y Year <br /> 12 <br /> w B 17. Frans otter 1 Acknowledgement of Reopt of Materials s' <br /> LU R 7fri.tTped Name ¢° Signajure T__Month Day„ r Year v <br /> LU <br /> U 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed ed Name Si nature Month Da Year <br /> T yp g y <br /> LU E <br /> N R <br /> Q <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> _ C <br /> L <br /> 20. F.C, <br /> Owner or Operator Certification of receipt of hazardous materials covered b 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 />