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State of Coliformo—Environmental Protetliop Agency _ C See Instructidns an back of page 6 Deportment of Toxic Substances Contra <br /> Form Approved OMB No 2050-0039(Expires 9 30 99) y Sacramento California j <br /> Please print or type Form designed for use on elite(f2 pitch)typewriter t <br /> 1 Generator s US EPA ID No Manifest Document No 2 Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS ; - rs not required by Federal low <br />' WASTE MANIFEST ! A +1 c - ' FE$ -4 1 ? JE of I <br /> 3 Generatif s Name and Moiling Address A State Manifest Document Number n �+ 1 <br /> CHASE PPOF EF'T`A J 6 G 416 i-..5 <br /> O 4 4 N. VAN T'UPEN. STOCKTON. CA 9- 5203 6 State Generator sIDin <br /> s f <br /> in d Generators Phone I�s_tr} D5E—02,64 1 <br /> 6 US EPA ID Number C State Transporter's ID <br /> N 5 Transporter 1 Company Name ! j <br /> � NOR CAL OIL f- AD '3 S2 l`.' W' k 5 D Tronspoder's Phone <br /> 1� <br /> 0D 7 Transporter 2 Company Nome S US EPA ID Number E State Transporter t 1D <br /> t <br /> J l E Transporter's Phone a <br /> n <br /> 9 Designated FaciLty Name and Silo Address 10 US EPA ID Number G State F it s ID <br /> � f <br /> a AH P1�t__EAN. INC (If <br /> x!-70 AL I"�CIND D�,. H Facility's Phone <br /> d S1I-VEF`- 'EFF lilk3E�n H ! i _F4: D N1 11D I rJ 22 l <br /> 9 <br /> 12 Conlomers 13 Total 14 Unit <br /> U11 US DOT Description(including Proper Shipping Name Hazard Closs and ID Number) No Type Quantity WI/vol I Waste Number f <br /> a Sta�e fir' <br /> Ht,7AI-T-,oL IS WAS rE I- I OU I D <br />' I 3 p f t T l'� EPA/Other j <br /> E State <br /> E <br /> o N b <br /> m E EPA/Other <br /> -a R <br /> A State <br /> O T c f <br /> O EPA/Other 4 <br /> R d State <br /> LU <br /> Z ' <br /> LU EPA/Other _� ! <br />' 3 Additional Des1 rrptions for Materials Lt ted Above # K Handling Codes For Wastes Listed Above <br /> a ^^ b <br /> Q- PURGE WATER � �J <br /> LU c d <br /> J <br /> Q <br /> Z 15 Special Handling Instructions and Additional Information <br /> a AF:F' FOFF-'IATE FF'OFECTIVE 1-LOTHIIAG <br /> Z ,i�=I�EF'GI•=r�ll-4� ,-nrITA�T: = w _.� ` _. (.�'ay).�y/- J/5fS <br /> w <br /> C�Fe =_. P. G. <br /> 16 GENERATOR S CJATLFICATION gnmnt ore fully and accurately described above by proper shipping name and are classified packed <br /> 1 hereby declare thof the contents of this consi <br /> S <br /> Q marked and tela and re in all respects in proper condition for transport by heighway according to opplicable international and notiono�government regulations <br />'J ' <br /> J If 1 am a large quonsity generator i certify that i hove a program m place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> CL practicable and thot I hove selected the racticable method of treatment storage or disposal currently avasloble to me which minim zes the present and future threat to human health <br /> p <br /> in and the envir merit R if!am a small quantity generator I have mode o good faith effort to minimize my waste generation and select the best waste management method that is <br /> a avo lablis to Ais and that I can afford 3 <br /> O Printed/T rP ed Na j ` Signature + Month_ Day Year <br /> f C <br /> T- <br /> Z <br /> 151 f Ln <br /> 1T 17 Transporter 1 fowled ement of Receipt of Materials <br /> I Printed/Typed Nam Signature MoDayLLJ <br /> ear I <br /> N onth J� <br /> s T`_1- ELIETT �( ! <br /> w P r <br /> is_ 0 18 Trans orter 2 Acknowled ement of Recer t of Materials <br /> r Month Day Year <br /> Q T Prented/Typed Name <br /> w <br /> Sig aWra <br /> E <br /> R r <br /> Q <br /> U 19 Discrepancy Indication Space <br /> Z F t <br /> A - <br /> 1 L <br /> 20 facility Owner or Operator Certification of receipt of hazardous materials covered b this maniFest exce i as noted m Nem 19 i <br /> Printecd/Typed Nome Signature Month Day Year <br /> y <br /> DO NOT WRITE BELOW THIS LINE <br /> ' DTSC 8022A JA/971 Yellow GENERATOR RETAINS <br /> EPA 8700-22 f <br />