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r ,t r . r•R a r Department of Heatth Services State of Caltforn�a—iiealth.and Welfaia Agency, + 7+ Tox�O Substances Control Division 1- Form Approved;OMB.No.2050--0«i9(EiplfOM,'9-30.9 �, r { ., y- x-,-:� Sacramento.California Please Print or type?'(Form,designed for'use on elite( ch typewriter). 1_ Generators US EPA ID No Manifest 2 Page I ' information in the shaded areas NIFORM HAZARDOUS v �, ° Document '. .` is not required'by Federal'law: WASTE:'MANIFEST` " ' A. state MnnNearatm+(] . 3. Generators Name and Mailing Address � N der -Deltat Alr Striakms '-•`15971 S','-,Tracy Blvd .F Traty,. -CA 9537Q f3tsta a Generators lD �. r 4. Generetora Phone(2Q9�-948-9345 (operator)' ' 5. Transporter 1 Company Name ' :. 8. US EPA ID'Number c state Transporters ID;-tV Refineries ServiceQ 9k D.'Trenapartera Phone =}r ; - vsmp n a S A!D umber . FE:TSrtaantesp.TorratnWaps Ptrone m 9. Designated Facility Name and Site Address 10. US EPA ID Number r State FacillWa IID a PLLF J Refineries 'Service 13331 N. , x FaewigP", �v Hwy. 33 Patterson CA 95363. � h " � W� 16 16 7 f2 M A.2Q9�-892-674 OLL 12.Containers 13. Total 14 � L �x 11. US DOT'Deacrtption.gi►cfuding Proper Shipping Name.Hazard Class,and ID Number) Quantity Unit Waste PP No. Type Wt/VOI .- _ t a. ORH - ar $talff L "de � Hazardous:_Waste' Liquid NOS -E. NA 9I89 EPA101det b a coE A `xis . ni R A cc Tc fQtlrer �" - 4 g p MAY Z 4 19y Sb - _ ++0 - - +3�'Txj• Jµ'�Y' .`PAF`IN�'�' a[ _ grateLU d s lL - .. ' - - -EPAlOth ` � J_Additional Descriptions for Matertals•Llated Aboveb �* � " xr �" ti K Handiing Codes.for.Waetea Listed Above { <e ksrtr�a K r i b g*k { �� r?t > T.r. sin*E V 4 �L, Vi 4.=,.,.. ~.vfR"` w �-. r r `f. Y .ef«, .,,'„u '+*'s• , +1 a '6,.} a: �u -#� -3' .'s a �' 's. x' .,wo9. ,+' _--_. w a s c� icYr s ty t A . ti)a83tt3 ,..rk a §-': r `^` r i.y ' i�-h'ka x. r } ;"r'� c-.,, d.�.•� '�x -.y^ ro _ Yc .�. �„ s.{ ;x�„ �•ayt 5 5` t'k��'`. -- ,. J '`� O - <b"^ .%� � x r:`x�t'd' �....,�e•ar`�4rt':•h.�st� .n•,+� r.m � 7'3r!Yx Y.. 15. Special Handling instructions and Additional information d Z - - uj J J d V J GENERATOR'S CERTIFICATION: t hereby declare that the contents of this consignment are fully and accurately described above by proper shipping.name and are classified.pecked,marked,and labeled,and are in all respects in proper condition for transport by highway according to,applicable international and CL national government regulations. 0: It i am a large quantity generator,1 certify that I have s program in place to reduce the volume and toxicity of waste generated to the degree I'heve determined 0 to be economically practicable and that 1 have selected the practicable method of treatment,storage,or disposal currently available to me whichminimizes the } present and suture threat to human.health and the environment,OR,if I am a small quantity generator,i have made a good faith effort to minimize my waste U generation and select the best waste management method that Is available to me and that I can afford: N.. Z Lu Printed/Typed Nama 1 Signata s.Month Day Year �(. , / T 17. Transporter 1.Acknowledgement of Receipt of Materi w 4L Z A Printed/Typed Name ' gnature- Month Day A` Year O S P- O 18. Transporter 2 Acknowledgement of Receipt of Materials R -d T Printed/Typed Name atu Month Day Year re U E z - _ 19. Discrepancy Indication Space F A - - - - - C t - . - L I20. Facility Owner or Operator Certification of receipt of-hazardous materials covered by this manifest except as noted in Item 19. T y Printed/Typed NameSignature Month Day Year_ DHS 8022 A(I 188) DO Not Write $slaw This line EPA 8700-22 (Rev.9-88)Previous editions are obsolete. Blue: GENERATOR SENDS THIS COPY TO DOHS WITHIN 30 DAYS To: P.O. Box 400, Socramerrto, CA 95812.0400