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11, <br />n <br />v <br />C <br />L <br />2 <br />LL <br />C <br />1k <br />LL <br />W <br />LL <br />C <br />LL <br />tr <br />U <br />C, <br />State of California—Environmental Protection Agency 7--185-01 <br />Form Approved OMB No. 2050-0039 (Expires 9-30.99 See Instructions on b page 6. Department of Toxic Substoncc <br />Please print or type. Form designed for use on elite (1 typewriter. <br />`--� DO NOT WRITE BELOW THIS LINE. l <br />I !. <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Document No. <br />2. Page I <br />Information in the shaded areas <br />WASTE MANIFEST <br />��$ <br />is not required by Federal law. <br />of <br />3. Generator's Name and Mailing Address MARTIN BROWER <br />4744 FITE CT <br />`A.'State•Mcnifest:&c6ment Number <br />2259030 <br />S't" OCKTON CA 95205 <br />B -'state Generators 1D' <br />n <br />A. Generator's Phone ( 249 946-3748 <br />V <br />o <br />5. Transporter 1 Company Name 6. US EPA 4D Number <br />Cr Sfate Tionsponer's IQ (Reserved:) <br />,. <br />SAFETY—KLEEN SYSTEMS) INC T 0 Q 0 3 <br />D. Transporler'sPhone: <br />p <br />I <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. Siate Trar iporter'i ID (Reserved.). <br />JTronsporter's <br />Phone,;• <br />9. Das* noted FacilityName and Site Address 6D 10. US EPA ID Number <br />G. State Facility's ID <br />DANBLV�TEMS, INC <br />A <br />5050TSAL I <br />a. Facility's Pliant <br />SAL IDA CA 9536B CAT000613968 <br />209 54.5-10)11 <br />11. U$ DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I: Waste Number <br />USED CLEANING COMPOUNDS,. N, C8. I. B. N. <br />DM <br />State <br />134 <br />G <br />LIQUID (NOT USDOT OR USE'IPA REGULATED) <br />` <br />:EPA/Other' <br />E <br />AGUEOUS FARTS WASHER SOLUTION ( 8. 3#GAL) <br />i N <br />b. <br />� State <br />i E <br />EPA/Other <br />t R <br />r A <br />t T <br />C. <br />State <br />O <br />"EPA/Other <br />R <br />d• <br />State . <br />i <br />\ <br />EPA/Other <br />r <br />1. Additional Descriptions for Materials listed Above �,k <br />Handling Codes for-1Nasteslisted°Above <br />a :b: <br />14 x4 <br />v <br />i <br />15. Special Handling Instructions and Additional Information "> <br />P g 0353 1 Ct 241890 �► 251 .5758 00102801301 24 <br />EMERGENCY RESP#800-468--1760 24HR <br />A 941 B C D <br />16. GENERATOR'S 'CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled, and ore 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 proggram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicall- <br />practicable and that I have selected the practicable method of treatment, storage, or disposal cu rently available to me which minimizes the present and future threat to human heold <br />and the environment; OR, if I am a small quantity generator, I have made a good faith eff minimize my waste generation and select the best waste management method that i <br />available to me and that I con afford. <br />Printed/Typed Name <br />Signature <br />nth ay Ye <br />ZM <br />BTransporter <br />1 Ack wleclement of Receipt of Materials <br />A <br />R <br />S <br />Printed/Typed N Signat M nt ay Ye <br />(' <br />P <br />0 <br />18. Transporter 2 AcknowlecrAel ent of Receipt of ateriols <br />T <br />Printed/Typed Nome <br />Signature <br />Month Da Ye <br />Day <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. FAilit Owner or Operator Certification of receipt of hazardous materials cover this manifest except as noted in Item 19. <br />T <br />Pri d/ ped No%,, I <br />Sign re / <br />Mo'nthh Da Ye <br />`--� DO NOT WRITE BELOW THIS LINE. l <br />I !. <br />