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0e0411meml at 1(aanh Services <br /> Stats of California-WYieallh and WM:ars Agency Toxic SubNances ContrW Alnsbn <br /> rm Approved OMS No.2060--0039(Ex(9e6 8.3691) Sacramento.CAWO Ma <br /> sass prrtl eflype. (Form doaiwted for u9•on 9ble f I2.0ch tYPOlislI9r). <br /> UNIFORM HAZARDOUS DQUS t. 0sneretar a US EPA W Na. ManiDocument ft 2.P:06 I In1am•ha+in tat ik zdsd arras <br /> WASTE MANIFEST � A 2 B t a not rrgw+d by Federal Tarr. <br /> 3.Generator's Nome and Moo"Address � A.81919 lrlamfe� �um <br /> ent Numb" <br /> Coca-Cola � <br /> 796198 <br /> 1647 E1 Phial, Stockton, Ch 9320S e,etaw awi«alora ID <br /> 4.Gsnaratw's Pliant( 2091-66649301 <br /> S. (tansar I CompanyY Noma e. US EPA ID Number G.Slsle TranaPoner'!ID <br /> Re fineries `Jarvi613 I D,Tnnapwts+aP <br /> n I T.Transpansr 2 Company Nem• 8. US EPA ID Number E.State TtanaPortera 10 <br /> x , <br /> F.Trastportar'a phoria <br /> 9.Otoi9rraled Facility Name and Site Address 10. US EPA f6 Humber G.Salta FaeilitY'a ID <br /> szm R®£ineriet3 Service <br /> 13331 N. HWY. 33, Patterson, CA 95363 tt Fa YaPhon. <br /> CAD 0 8 3 1 t5 6 7 2 8 <br /> 209-692-6742 <br /> ' 12,containers 13.Taint 14. 1. <br /> p 11.US 001 Deactrpuon(Including Proper SNparvg Name,Asgard Class,and to NumbrNo, Type t) Quantity Unir Waste No. <br /> u, WIIVDI <br /> CW •' Ha;rardaue Watstfs Liquid NO3 ORM-19 NA9189 cute 223 <br /> E T l B EPA I Olhar <br /> 3 N state <br /> E b. <br /> EPA/Other <br /> Co T <br /> vI O <br /> Stats <br /> v--R e. <br /> X EPAi Othat <br /> state . <br /> 2 <br /> IL EPA7Qth9f <br /> L:r <br /> 2IJ.Additional Descriptions for Materials lrltad Above a.F(arldlirtq Cads fDf W brei Lulad Abase <br /> LU <br /> 00...rf, _, " Glx <br /> r�/�7e�- 9' 7 �� <br /> i Id. <br /> Le nJ <br /> Hy - 15. Special Handling Inalruahona and Ad rtional Inldrmal+dn <br /> GENERATOR'S CERTIFICATION. I hereby declare that the contents oI this Consignm►nt ar■fully and accurately bescribad above by Proper shipping Pamt <br /> -I and are c4sarfied,paekad.marked,and Wanted.and are W a0 respects in Proper eonddfon for transport by highway according to applicable lntMnah0nal and <br /> G'", national government moulationa. <br /> V <br /> � <br /> � 1f E sin a large economically <br /> generator.(caddwielded HM <br /> NW <br /> Ilial!have a Program le plass to reduce the volume and Wooly at waste genareled ID(be dagrdegreeI have determined <br /> 1 to be economicapracticable And that I have wd ft Practicable H NW of treatment.storage,or disposal currently available Io m•which minimizes the <br /> Ilk preacnt and future threat to human hnmt <br /> eh and the rnrfrDr9nP OR.It I amt quantity,generator,I have made a good faith eNon to minimize MY Matte <br /> i V gewxalron and select the best waste maru0ament method that Is 9raile o me lid Mat 1 can d! <br /> 2.. signature A( .th Day Year <br /> U <br /> Printed prtl Nemr <br /> W TGk,,k, 121 CA' <br /> T 17. Transporter 1 Aeknowiedgrletnl Of Receipt of frlslsnats <br /> RS, Month DAY year <br /> A PrMorilTYpad Nome r^•- rte • <br /> U 5 t—c rN hnI YJ 4 71 <br /> Q <br /> cr PO 1 naportM 2 Acknowledgement at Recaspt of anal• <br /> �. T PrintetlriYpetl Hama Slgaature AfcntA Day Year . <br /> ( E t <br /> 19.Olawspancy indtcal"Spore <br /> F <br /> A <br /> C <br /> 1 <br /> I, __ 20._Facddy.Oki_or opMMor Gertdtca ti n of recsrpl of hazardous malensis covered by this manlWn excret as noted m Item 19, <br /> . Month Day... Year ----- ------- -------- --.. <br /> . y Printedr TYPed Name Slpnatvre <br /> DNS 6022 A(t meal Do Plot Write Below This Line <br /> EPA e700-27 - - - Blue:GENERATOR SENDS THIS COPY TO DOHS WITHIN 30 DAYS - <br /> (I 's.0-8e)Previous oddirrta are Obsolete, - <br /> To:P.O.Box 400,Sacramento,CA 458124AW <br /> DOCLEW <br /> CANNff BE <br /> IMPROVM WE TD TW <br /> COMITION OF THE MOI11& <br />