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State of California—.Environmental Protection Agency �185-01 <br /> jorm Approved OMB No.2050-0039(Expires 9-30.99) See Instructions on back Of a 6. Department of Toxic Substances Control <br /> lease print or type. Form designed for use on elite(12-pitch) iter. Sacramento,California <br /> ' 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded ureas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST C� �4 17 <br /> , of � <br /> 3. Generator's Name and Mailing Address INTERLAKE A. State Manifest Document Number <br /> 1029 S SACRAMENTO <br /> 0 - 9 —47.9 B. State Generator's ID <br /> n D C <br /> A. Generator's Phone <br /> (209) 333-3500 7 <br /> CV 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID(Reserved.) <br /> h v. <br /> 00 <br /> 6 SAFETY-KLENTN SYSTEMS, INC ® D. Transporter's Phone <br /> O r9R „ L I <- *.. <br /> q�°D 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> F. Transporter's Phone <br /> �Q <br /> V 9. Desi nated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> Q F TY-KL LEEN SYSTEMS, INC. T O 1. <br /> °®z 5050 SALIDA BLVD <br /> AL I DA, 953683 CAS. 000613968 H. Facility's Phone <br /> o545-1011 <br /> w <br /> e < 12. Containers 13. Total 14. Unit <br /> ..a° 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> V No. Type Quantity Wt/Vol 1. Waste Number <br /> = WASTE COMBUSTIBLE LIOUID, N. O. S. DM state � <br /> (PETROLEUM NV Pt Tp'g )) N�A1993 PQIII p�pryp EPA/Other <br /> Me, <br /> ,;4 b, .State <br /> co E WASTE COMBUSTIBLE L I OU I D, N. O. S. 74-1 <br /> 00 (PETROLEUM NAPHTHA) NdA1993 PGIII RGDM P EPA/Other <br /> Nv A ( O1)E 12 (fir. 7 /QL) (DO1 , 39. D O) <br /> O T c. State. <br /> °0o O <br /> R EPA/Other <br /> LU d. <br /> State,: <br /> Z <br /> w <br /> V EPA/Other <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> I (A) D018 D039 (A) D040 <br /> N I{ ) 1 0 ( ) D #0 r 14 b'14 <br /> LU r c. d. <br /> a <br /> Z :4251286 00241577q�q <br /> 15. S ecial Handling Instructions and Additional Information . . <br /> ° E RGN doNCY RESP SOO �6 -1 760 2 0 <br /> Q <br /> Z <br /> = A 704 B 801 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 /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> V <br /> 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 /> n practicable and that I have selected the practicable method of treatment,storage,or disposal 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 faitheffort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> O / <br /> } Printed/Typed Name Signature ( iiJ onthfJl /ypDay Y ar <br /> f /' <br /> W T 17. Transp er 1 Acknowledgement of Receipr6rMaterials 4 <br /> C7 R <br /> LU A Printed/Type Nance"""""° Signature Month Day Yjecr <br /> N C^ <br /> w P i..! <br /> LL. p 18. Trans ter 2 Acknowled ement of Recei t of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> LU E <br /> N R <br /> Q <br /> V F 19. Discrepancy Indication Space <br /> Z A— <br /> 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> ! Printed/Typed Name Signature Month Day Year <br /> 1 <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />