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Stofe a cfifomb-Heafth and WeMafe Age+xy $eta�f15}ructions on bock of:''µ9e 6, ]axle Substances Control Program ' <br /> Socrarmento•Cotltomio <br /> Form designed for use on eee(12-pilct rrifer). ' <br /> M�a F or type. 2..Page 1 1n,orrnotbn in the stmadad a'eaf i <br /> 1.Ge'rrerolor'f US EPA 1D No. Manifest Document f+to. <br /> iFORM HAZARDOUS If notrequredbyFederaltov <br /> �^ s.Generat'WASTE MANIFEST 1 1 1 1 1 1 . 1 1 1 1 1 I r 1 1 <br /> uN a Sfohn Moi�iresl aoCur.,enl rWmber Q�* <br /> l of.Nameamdt +ngAddrev Canteen ServJar.O s ►V1 JV . <br /> ate aerators <br /> i <br /> 1500 Shaw, R. , Stockton, CA 95215" <br /> A,Generalor$Phone( 91f� 466--2709 <br /> 5.traporter I Company Name <br /> 6.115 EPAIDNtdsmber <br /> nsC SfateTrasnportetllD <br /> PTS Environmental Service C I A t D 19 18 1210 14,0 1 2 1016 D:?iO^spO"err Ptmata 916 X52 6 <br /> £ Slate Troretprirter>t I d <br /> 8.US EPA ID Number D <br /> 7.Transporter 2 Compohy Name - <br /> E L.7, t�vru ars phorw Yrt3 <br /> 10.US EPA iD Number G-Stam a lac s iD .. <br /> R 9.DesignatedFaciityNameandSlleAddrev 1:-' T,UI,�l,':�1 1 :I:,�3t J :�..'2� H <br /> fn <br /> Refinery Services H:FadtdyiPhone ` <br /> 13331 N. Highway 33, <br /> 12.Containers 13 Total Td.Unit <br /> p per}-¢ �• p j� Xg953.6 Na T 9uanf WINaI:Wastehr,;rf�ber <br /> c0 11. U01Vescre+P-1'ion[r�icErdi 9 I'roPsr Sh+p-1-1D Hord Glass.ord ID Number) ---' <br /> -.t a - <br /> U G Fuel petroleum oils=nos. , Combustible Liquids t. <br /> V <br /> D c N b. <br /> n 0 E <br /> V Q A <br /> n(' T <br /> z 1. <br /> n z 0 EPA7«her <br /> R <br /> n d <br /> sate <br /> V <br /> J Adddbnd DeSCliptrons io(Wtoteriak.trMe.C. ov9 <br /> K Handing Codes for Wastes toted A <br /> laova <br /> r >w1 b�3 s �tilTnc �t:~xmLnel amaznt o hal€ygE: <br /> c <br /> T!, b <br /> � S�a$t� <br /> I <br /> {} <br /> 15.Special}tandt'ng Irssirucliort and Additional Information LU <br /> z Capital Tank Service � <br /> a 2518 B & C Alley — � C\1�� <br /> c <br /> Sacramento; CA 95816 <br /> J 16. GENERATORS CERTIFICATION: 1 hereby declare that the contents of this consignment ore fully and occurotety doscribed above by proper'shippirg name and ore ctossirod, <br /> Q <br /> Opocked,maned.and lobated.and ore In all respects in proper condition for lrarsspott by htgimwW according to applicable international and nplional government reguloibns <br /> V- If I am a large quantity generalof. I cedify that I have o program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be <br /> Q economically practicable and that I have selected the practicable method of lreahmmenf,storage.or disposal curentfy ovaloble to me which-minimizes the peesent and future <br /> Z <br /> LUUveahuman <br /> ,to hoolth and the erwironmeal:OR,V I am a small quantify gerwalor.I have made a good faith effort to mir-mize my waste generation and select the bast waste <br /> - <br /> r management method that Is avorlable to me and Itiot I con afford. <br /> tPrin,ed/fyped Nome Signature Monts t7ay, ' Year <br /> 'KAAe. 1 <br /> a <br /> C rss <br /> T 17.Troporter 1 Acknowledgement of Receipt of Mdenals <br /> O R Printed/ly me Signature Month Day Year <br /> LU s <br /> i 0 P <br /> 18.Ttonspoder 2 Ackno%-Aodgement of Rece' 1 of Mdariats <br /> r U" R Prhfedlryped Name Signature - Monfh Day Year <br /> Lu T <br /> oC <br /> RLU - <br /> Cn 19.Dscre Indication Space /J�rE r <br /> U F 6or F� ���/�- r_, =(uE�yf1 �l E/J✓l�r>!4/J�'lF".Jr4c <br /> iI Z A <br /> C . •D,' <br /> 20.Facifty Owner or Operator Cerlggio ion G receipt of Ivsadous mderiab covered by this manifesl except as Holed in'dem 19. <br /> Printed typed Name Signature - Monm Duy Year <br /> j Y <br /> I DO NOT W§1TE BELOW YH1 <br /> White: TSDF SENDS 11 IIS COPY 10 DHS WITHIN 30 DAYS. <br /> DHS 80224(12/90) <br /> To00 <br /> : P.O.Box 30 .Sacramento.CA 95812 <br /> EPA 8700-22 <br />