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State of Colifomia—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-3496) See Instructions 061 back 9@ 6. Deportment of Toxic Substances Control <br /> Please print or type. form designed for use on olive(12yt' writer. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 I Information in the shaded areas <br /> WASTE MANIFEST <br /> is not required by Federal law. <br /> Of, <br /> 3. Generator's Name and Mailing AddressA, R1, <br /> RMC LONESTAR � � <br /> P.O. BOX 5252t PLEASANTON CA 94566 �& 4 -' <br /> C4 <br /> to 4. Generator's Phone00 <br /> 426 <br /> ) —2279 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number <br /> ti k 5; <br /> ...n d } N <br /> 7. Transporter 2 Company Name S. US EPA ICF Number <br /> U <br /> Z 9. Designated Facility Nome and Site Address 10. US EPA ID Number <br /> �. <br /> & H SHIP SERVICE COMPANY <br /> CD a 20 TERRY FRANCOIS/CHINA BASIN'AN FRANCISCO., GA-.- QA107 <br /> ' <br /> Containers 13.� 14. U <br /> Z 11. US DOT Description(including12. Total nitg Proper Shipping Name,Hazard Class,and ID Number) No. T Quantity wt/vol <br /> RESIDUE DIESEL TANK <br /> G NON-RCRA HAZARDOUS WASTE SOLIDT p <br /> ct E <br /> 000 <br /> N b. <br /> v E -ftE8iebE--&AS0Ef*E-4A*K- e9 <br /> � <br /> C'4 R <br /> A C. <br /> w T <br /> 0 RESIDUE OIL TANK <br /> W R NON-RCRA HAZARDOUS WASTE SOLID T P Q P <br /> Z d. <br /> Z <br /> w <br /> U <br /> LU <br /> 0 <br /> t <br /> Z <br /> 0 15. Special Handling Instructions and Additional Information <br /> Z OB#16507 JOB SITE: <br /> LU 4 Hr. Emergency Contact: H&H #(415) 543-4835 30350 SOUTH TRACY BLVD. <br /> t- EAR APPROPRIATE PROTECTIVE CLOTHING TRACY CALIFORNIA <br /> —' 16. TOR'S TIMI: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and arc classified, <br /> r <br /> Upacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations. <br /> If I an a largo quantity generator,t 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 <br /> 4 <br /> economical able and that I have selected the <br /> economically practic practicable method of treatment,stooge,or disposal currently available to me which.minimizes 9fne prosernt and future <br /> threat to human health and the environment;OR,if I am a small quantity generator,1 have made a good faith effort to minimize my waste generation and select the best <br /> 09 waste management method that is available to me and that I can afford. <br /> 0 Printed/TYPed re Month pay Yea <br /> U T L>EY - 11 12 1.4 10 16 <br /> W t 17. Tran 1 A of R ' of Materials <br /> A Printed/Typed Name re <br /> Day Yeas <br /> w v JIMMIE H. REESE 1 12 13 19 t6 <br /> W, 0I S. T r 2 Acknowleciatermw of Receipt of Materials <br /> ® <br /> T P^ntod/TYPod Nano Si <br /> H gnWeMorN1► Day; Y�r <br /> R <br /> U) 19. Discrepancy Indication Space <br /> taj F <br /> A <br /> Z C <br /> 1 <br /> L <br /> I 20. Fodlity Owner or Operator Certificationof recei of hazardous materials covered by this manifest ex as noted in Item 19 <br /> Pnnled Name <br /> Y Signature Month, yew, <br /> DO, NOT WRtTF BELOW THIS tl � ' � <br /> r To: [u O Box$000 <br /> EVA' <br />