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** 6e7'39Ud -1U101 ** <br />Slam of Califamia—Environowial PralWia+ Agrroey <br />Payer Approved oma Na_ 2050-w3f (Et es 9,30.941 7-1e5-01 See Inelruetions an bock of page b. Fsepartment of tonic ",ta an conga(`, <br />plaat* print a type Form 4�uignd far.sa an @rf+ F12-pikhf lype+�rr@r. Saers�r ®nb, cofjFw+Ha <br />UNIFORM Iii 1, C—.r°for'.. US EPA 10 No. MaarpW <br />nifasl Document No. 2. Pug 1 Iniion in The shoed Argas <br />t, $ it noted b <br />rogel/f Pedaroi inns <br />WASTE MANIFEST I q of <br />3. Owerator't Name and: v aing kidtess 1 i% A 41g1i Nmdfas►Qostirn4ett Natpb;r <br />29, <br />r• i, I <br />1y <br />A. Gig <br />@rabr's Phetr <br />f All <br />5. Trawtporler 1 Como" Mama 6. tis EPA 10 Number C. '*1c 1in�xpnler~e,if? <br />SAFETY—KL1EEN SYSTEMS INC. TXR000050930 <br />g .,.phi ,':;�E�'; ,��,�•y���. r <br />. Tomtporter 2 Cwnpa.y Nests 9. US EPA ID Number �•�,S Tmn ;� .` ,^' • •�" - <br />P.Tr9P.4orjefe t•' • ., V' ti %•i(eirt� p2 <br />4. Dedgeated Pacil y Nana and Slat Addratt 05014 4 10. US EPA Ip Number <br />LEAN HAREOIJ SAN JOSE. LL <br />1021 DERRYE A RD CAD059494 310 N, lietpjhy+'%�brt:�;-Y,• , �„�� ' t � � ; � i <br />SAN JOSE CA 95133 <br />V, > 12. CeMain@r. , • t3. Tolad 141. U.it � � , <br />11. US DOT Descriotim l ttehdetg Proper Shipping Name, Nazand Claes, and ID Number) <br />z NON -RC, HAZARDOUS WASTE LIRUID <br />OIL,WATER LUDGE(NOT DOT REGULATED) <br />3 G. <br />E b. <br />ea' N <br />m E <br />R <br />A e. <br />g T <br />w O <br />R <br />d . <br />Na• <br />0 <br />TT <br />K.. F*dling Coda; for Wc%1a Uited Abvia <br />1 <br />1 r'V <br />40 <br />is. <br />xy:P �r_ �1,: 'rte' a. d', <br />6t} 4 1 F r r <br />FIs.sp=WHanding Imnadioa.and Additional Information 'MF'ST R/T# RROQOQ000 O—OOO—QO <br />EMERGENCY RCXP 404-468-1760( a4,tfR ). IF UNDELIitERABLE RETURN TO GENERATOR. <br />z SK CORP AUT-MOR119D TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARFv ' <br />KDOT# At 3257 H: C: D: <br />16. TW5 CIRl1Fr<FCATIeNt F Mreby dinar* !lion the r®rmntt oi,lhie teedgNnenl an Fill and oeeura y dastreted obawa F,y prgmr *h name end are dasdRed, Pncfnd, <br />marred, emd kelmled, aid are in oN respects fi proper condl"on far ironspart by,highway oscordinp to op 4A10 twlernafionef and ro6o uaf g eremanl requlaNars. <br />s If I am o Fuge grcr, ganereior, I rwtFy !love I hon a program in plea to reduce dm vwme and toxicity of wail@ gonerared no Tee degrea I haw da ern meal to be ooawem104 <br />preatlM awe arm,Bho! F bare ielae4rd p►aerieabia m®Ihod of !r@arnemi, slorvg@, or dlspotal oulrenilr r.albbF. is m. which minims res the present and fuk,ro d+rrol b hua�1 hadlfl <br />end the endnmerenii OR if I am a small geawly gararoMr. I Few* mods a goad Foith .Man to minimize my watts generation and talent the 4iast waste m°ragem@M mediad 11040 is <br />Q ere! ble to Mnew 4” 1 car afford. <br />PrintedName SrygnoGro / i i Mood Day TW' <br />t PriettedfTyped Noma r <br />Signature <br />9ignetwo <br />D6011022A 11/991 <br />EPA 8700--22 <br />60'd 6SE6179b 01 089S 9179 602 <br />Dory 7eer'.t <br />it n nem 1 <br />Month Day Year <br />Liz c <br />THIS LINE. <br />®Teen: TRAN$PORTER RETNHS <br />1098Tz—AS NA 92!11 E66T 91 Nnr <br />�1T. <br />Tt� r I Ae oI Rate <br />A <br />P'wed/Typ*d Nam. <br />Uj <br />W <br />1It <br />�J <br />IR. Trona Rem <br />PrintedfTyped Nam* <br />Uj <br />M. <br />19, 4lecr@ponty Indicant n, Spann <br />s <br />A <br />C <br />1 <br />L <br />f <br />ZO i tjnrr!er or rover [ertlFiexttia <br />t PriettedfTyped Noma r <br />Signature <br />9ignetwo <br />D6011022A 11/991 <br />EPA 8700--22 <br />60'd 6SE6179b 01 089S 9179 602 <br />Dory 7eer'.t <br />it n nem 1 <br />Month Day Year <br />Liz c <br />THIS LINE. <br />®Teen: TRAN$PORTER RETNHS <br />1098Tz—AS NA 92!11 E66T 91 Nnr <br />