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State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) <br />Pleasgprint or type. Form designed for use on elite f 12•pfkh) er. <br />0 <br />to <br />h <br />00 n <br />N <br />00 <br />0 <br />0 <br />C? <br />CD <br />Lag Q <br />w U <br />000 <br />U <br />Z <br />N <br />0 <br />m <br />W <br />v <br />N <br />O <br />O <br />00 <br />M <br />r <br />Z <br />U <br />W <br />to <br />Z <br />O <br />N <br />Q <br />Z <br />O <br />a <br />Z <br />W <br />x <br />r <br />Q <br />U <br />N <br />oc <br />O <br />U <br />Z <br />0 <br />W <br />I <br />UjW <br />O <br />N <br />Q <br />U <br />See Instructions on back of pag Department of Toxic Substorces Control <br />Sacramento, California <br />DO NOT WRITE BELOW THIS LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 8022A (1/99) To: P.O. Box 3000, Sacramento, CA 95812 <br />EPA 8700-22 <br />1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 <br />Information in the shaded areas <br />UNIFORM HAZARDOUS <br />is not required by Federal law. <br />WASTE MANIFEST <br />CRD 9 8 1 1 6 3 9 7 5 1 17 19 5 16. aft <br />3. Generator's Name and Mailing Address so N <br />A. Slate Manifest Document Number <br />STOCKTON USD - TRANSPORTATION DEPT. <br />2,2817856 <br />2963 SANGUINETTI LANE <br />B. state Generator: Io <br />STOCKTON CA 95205 <br />4. Generator's Phone ( 209 3,4084 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Tronsporter's ID (Reserved.] <br />ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 8 <br />D. rranaparters Phone (800)974-4495 <br />7. Transporter 2 Company Nome 8. US EPA ID Number <br />E. State Transporter's ID Reserved.] <br />LlF. <br />Transporters Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. Stale acili rs(Q <br />DEMENNO / KERDOON <br />10 91 r <br />"' Faty`s Phone <br />2000 NORTH ALAMEDA STREET <br />COMPTON CA 90222 ICAT 10 18 10 10 11 13 13 15 12 <br />310 37-7100 <br />11. US DOT Description (including Proper Shipping Nome, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14. Unit <br />Wt/Vol <br />1. Waste Number <br />No. <br />TypeQuantity <br />State 223 <br />NON RCRA HAZARDOUS WASTE LIQUID, (OILY WATER) <br />IS, <br />EPA/Other <br />O <br />T <br />G <br />Ca <br />NONE <br />E <br />b. <br />State <br />E <br />EPA/Other <br />R <br />C. <br />State <br />T <br />O <br />EPA/Other <br />R <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Fjggdill Codes for Wastes <br />Listed Above <br />11A) 224904 <br />I <br />C <br />d. <br />j 15. Special Handling Instructions and Additional Information <br />USE PPE EMERGENCY CONTACT :CHEMTREC 1-800.424-9300 <br />NAERG * 11A. 171 <br />j SITE: TRANSPORTATION DEPT,1932 N. EL PINAL DRIVE, STOCKTON, CA 95205POA 0 =.2m 2.12AAOMD <br />16, GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuratelyy de rib hove by proper shipping name and ore classified, pocked, <br />marked, and labeled, and ore in all respects in proper condition for transport by highway according to opplicobie inlernalional and national government regulations. <br />If I am a large quantity 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 />practicable and that I hove selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and Future threat to human health <br />and the environment; OR, if I am a small quantity generator, I have mode a good faith effort to minimize m waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />Printed_/Typedd�N /� <br />Signa r <br />Month Day Year <br />1010.17.01 <br />T 17. Transporter 1 Acknowledgement of Receipt of Materials <br />Print_ /Typed <br />Signature <br />Month Day Year <br />Ni <br />013 <br />5LLLa <br />P <br />B <br />18. ans rter 2 Acknowledgement of Receipt of Materials <br />Printed/Typed Name Signature <br />Month Day Year <br />Ei <br />R! <br />'. 19. Discrepancy Indication Space QUAN I I IT 015CREPANEA ER THAMIDVARIATv RE NCIL,� <br />A WITH Gj,N��ERCATOR/TRANSPORTER 0 ITH <br />®E.—,__! _Y RECEIVED �`� . GALLONS <br />L <br />I <br />i 20. Facili Chmer Operator GYrtification of receipt of hazardous materials covered by this mani t ex e t as noted in Item 19. <br />T <br />ria /Typed No _ \ <br />Signature <br />%Mon»h Day Yea <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 8022A (1/99) To: P.O. Box 3000, Sacramento, CA 95812 <br />EPA 8700-22 <br />