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, <br />_ate of Cailfornia—+ieahh and Welfare Agermy ',. � 6 fnitrO'ctlons on Back of PaB 6 ' ' antn.nt of <br />orm, Approved OMS No. 90f50-0039 (Expi 1) Wti4 eta" Control owlakm <br />I+ront of Paha 1' <br />,.aa� printor type. farm dsafgned'itiiuie e f ib pooh j,ttd <br />s.ruamentq, Cailfomla <br />t. Generat S EPA 10 No. Manifest <br />'UNIFORM HAZARDOUS <br />2. , age Information In the shaded areas <br />s <br />nt <br />WASTE MANIFEST ra"i <br />or -; `.`1 is not required by Federal law. <br />3. flea tor'a Nam Mailing AdQress < <br />tIj L y t s.t,p i 1 <br />A. <br />W4 <br />r11 <br />d. Generator's Phone D �� r 7 <br />S. Transporter t Company Name 6. US EPA ID Number <br />C, data i a <br />7. Transporter 2 Company Name S. US EPA ID Number <br />i&r' 9; "•, f'e) } ,, ; •; <br />rteYa < � � <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />ire <br />�,3 y <br />R> s <br />Alba oil Mot <br />M <br />Sea "Ort SlYdc <br />Aim <br />12. on ainers <br />13. Tota - <br />1477. 1 <br />11. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) <br />Yluentky, <br />Unit " Mysaie No <br />No. <br />Type <br />Wt/vol <br />a. BQ Hazardous Vast* Lkuids $ , S <br />ote1� <br />E <br />N <br />9 <br />131611 <br />A;� <br />Other <br />E <br />b. <br />S4ate <br />R <br />T <br />1A/EitheF. <br />R <br />0. <br />to <br />/ <br />fDSt�lr ' � <br />d. _. <br />> ate <br />0000 iptkms for Materials Usted Above <br />it. <br />Codes for p!aistea <br />AtfoYe <br />�s abntiacrz�, eb i rt <br />4 Va�tai r a 6 " 41r taRl <br />C. <br />16. Special Handling Instructions and Additional Information <br />Gibson Oil 1'asto 5re P ile �` Q � <br />24 Itrr t&et - tt Z4 I >c� a ..4 46- <br />& iRECEI <br />,e.MAY <br />12 1992 <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately de e b r r shipping name <br />and are classified, packed, marked, and labeled, and are in all respects In proper condition for transport by highway international prod <br />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 generatL4di4aidagta41'bave datgrr�jni ed <br />' <br />to be economically practicable and that I have selected the practicable method of treatment, storage, or <br />disposal currently available to me which minimizes the <br />present and future 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 <br />generation and select the best waste management method that is available to me and that 1 can afford. <br />Printed /Typed Name <br />n ure <br />Month Day YearC. <br />y <br />� .1 a f / 1 fes+- <br />it- <br />T <br />17. Transporter 1 AcknoWedgement of Receipt of Materials <br />R <br />Printed/Ty p N�elne� <br />Signature <br />Month Day Year <br />SA <br />N <br />I4A '!l OO <br />O <br />1 � <br />N al 09 1 <br />1S. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />Printed/Typed Name = <br />Signature <br />Month Day Year <br />E <br />/9. Discrepancy Indication Space <br />F <br />A <br />I <br />I <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in hem 19. <br />T <br />y <br />Printed/Typed Name <br />signature <br />Month Day Year <br />1 <br />' <br />W22 A Do Not Write Below This line <br />8700-22 <br />8-80 Previous editions ars obsolete. : GENERATOR SENDS THIS COPY TO DONS WITHIN 30 DAYS <br />To: P.O. Box 400, SwomeMo, CA 95812 <br />Al'&' <br />