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'91 of California—Environmental Protection Agency 7-185-01 <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back ofa 6. Department of Toxic Substances Control <br /> Pleas tpriitt or type. Form designed for use on elite(12-pik Oriter. dr Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS CA 7464290129780 f is not required by Federal law. <br /> WASTE MANIFEST of <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> I029 S SACRAMENTO 217470431,1, <br /> LOD I CA 95240-4799 B. State Generator's ID <br /> A. Generator's Phone ( 209 333-3'r00 <br /> Fd 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's 1D[Reserved.] <br /> h <br /> OD <br /> SAFETY -ALEEN SYSTEMS*« INC CR000075150 D. Transporter's Phone "" <br /> O O' <br /> op 7. Transporter 2 Company Name 8. US EPA ID Number- E. State Transporter's ID[Reserved.] <br /> J F. Transporter's Phone <br /> Q <br /> 9,aDd S' A d 10. US EPA ID Number G. State F il'ty <br /> Ic <br /> - 6000- SBTI� � TRE T <br /> � '�•#�'t...RAMENTO CA 9 5 Z Cd�t fe�n�.$a. 084 €.7 H. Facility's Phone <br /> 0 916 "" 491 <br /> r"f—' 12. Containers 13. Total 14. Unit <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> U No. Type Quantity Wt/Vol I. Waste Number <br /> _ a. <br /> USED CLEANING COMPOUNDS, N. O I. B. N- DM 2� State <br /> G L I QU I O €NO DOT <br /> OR �'A ����L�T�I�> EPA/Otheir <br /> tAOUEOUS PARTS WASHER SOL UT I Oki (8. 3#"L) <br /> 0 N b, State <br /> 00 <br /> aE x <br /> v R EPA/Other <br /> A c. State <br /> o T <br /> coo O <br /> R EPA/Other <br /> Lu d. <br /> State <br /> t-- <br /> Z <br /> w <br /> V EPA/Other <br /> J. Additional Descriptions for Materials`Listed Above K. Handling Codes for Wastes Listed Above <br /> a. <br /> 14 b. <br /> Lu <br /> c. a. <br /> a <br /> O 1 S li n tru i i'o al In or on e �3192t <br /> I 2*96 1760 24HR <br /> Q SK AUTHORIZED TO RETAIN LICENSED SVBSEQUENT" CARRIERb AS NECESSARY. <br /> Z <br /> _ A 941 B C D <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 /> Umarked,and labeled,and are 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 /> o practicable and that I have selected the practicable method of treatment,storage,or di IF al currently available to me which minimizes the present and future threat to human health <br /> ti <br /> and the environment;OR,if I am a small quantity generator,I have made a good fait eFFdrt to minimize my was tg generation and select the best waste management method that is <br /> available to me and that I can afford. j <br /> O <br /> } <br /> Pr i d/Typed Name Signature '` Month Day Year <br /> w T 17._Transporter 1 Acknowledgement pf Regitipt of Materials <br /> C� <br /> w A Pr1n d/T ged Nam .`p e .m�;.Signatur t"_. _ Month,,. -pay Yea[.,„ <br /> *�y <br /> S 11 +e. A <br /> u_ 0 18. Trans iter 2 Acknowled et l nt of Receipt of Materials <br /> O TR Pri fed/Typed Name Signature Month Day Year <br /> w E <br /> v7 R <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> i <br /> L <br /> 1 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T, Printed/Typed Name Signature Month Day Year <br /> DO NOT WRItE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />