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State oto �. a-�isiNh' end weMare Agency ` Soo Instructions Ott Back of P � �CRrppartment of Health Services " <br />Form 8 N 20 (Expires 9-30.91) Toxic Substances Control Division <br />Please` <br />' ` .;or e. designed tot use on elNs 1P kcli and Front of Page 7 r <br />P ( p typ ). Sacramento, California <br />u. IF®M HAZAR®®US . 1.'Osnerator's U$ EPA ID No. Manifest 2. Pape t , <br />Information In the shaded areas <br />ASE MAN'FESTn4 <br />Q . 0 04 <br />Is not required by Federal law. <br />3. ,Cienser�tror's Name and Mailing Address no nr A ` ate MenMelst <br />la. <br />r Gff rHNP '• g5,•i <br />to earwatoes ID 777, <br />4. General oes Phone )Fr -y <br />e orter t Company 'c S U8 EP State !` <br />T. Transporter -2 Company Name e. US EPA Number <br />9. Designated Facility Name and Site Address /0. US EPA ID Number F <br />�tcga <br />�A Pffirr slvda <br />s <br />tehaftilt Cat 94601 <br />w^' <br />19. 'US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers 13. Total <br />Ouantity <br />14. <br />Unit rYiF NoK ; <br />No. Type <br />Wt/Vol ' <br />a. -_storage Tank <br />State <br />E <br />—RICRA` *asaardous West,& ` oil G <br />P EPAtL <br />N <br />E <br />R <br />b. <br />State <br />¢ <br />A <br />TAtt#aal►r <br />0 <br />x <br />F <br />R <br />... <br />Q <br />d-- <br />,. <br />EPA7 <br />J..Addilionai Vesoriptions for Materials Listed Above <br />sy8r Storage n <br />IC. - Codec rex Waal <br />es 1.10ed /drove <br />y <br />` <br />Tank (a) hot tl <br />C. <br />d. <br />lice r 101010 Calc CsipaiUtys, <br />{ <br />15*jgIel Hr4dling I tructions and Additional In`o ation <br />a <br />P lilt y From sources of gait one Always wear hardhets a}rhetirk#,I�g� <br />i!is',5'iTv®4 <br />24 111r,&111r,&tBCt N %4 _ <br />L L-- & hOn / <T <br />GENERATOR'S CERTIFICATION: i hereby declare that the contents of this consignment are fully and accurately described above b`sh�pPjt <br />and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to appyc int n ogn <br />national government regulations. E �% (�� <br />If 1 am a large quantity generator, 1 certify that 1 have a program in place to reduce the volume and toxicity of waste generaTed tb ei'ig U4eVigLr4 #L I <br />be <br />to economically practicable and that 1 have selected the practicable method of treatment, storage, or disposal currently avail i� I�i�izpp <br />present and future threat to human health and the environment; OR, M i a small <br />am quantity generator, I have made a good faith diirdln$ b C <br />generation and select the best waste management method that is available to me and that 1 can afford. <br />I r. <br />Printed/Typed Name Signit4re Month Day ,Year <br />T <br />R <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />A <br />Printed/Typed Name Signature Month Day Year <br />P <br />f *t. <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />ER <br />Printed/Typed Name <br />SI nature <br />® Month Day Year <br />19. Discrepancy Indication Space <br />F <br />A <br />a». <br />C <br />i <br />L��� <br />,1 <br />T <br />20. Facility Owner or Operator Certification of receipt of hazardous mats els covered by this manifest except as noted in Mem 19. <br />'A <br />y <br />Printed/Typed Name <br />Signature Month Day Year <br />8022 A Do Not Write Below This line <br />` <br />8700-22 <br />8-89) Previous editions are obsolete. <br />3 <br />Blue: GENERATOR SENDS THIS COPY TO WHS WITHIN 30 DAYS <br />ToJ.O.BQx400,So0WrWft,CA 958124M <br />