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State of California—Environmental ProtectionAgencyi %:[.
<br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of10 6. Department of Toxic Substances Control
<br /> Please print or type. Form designed for use on elite(I 2-pitch) er Sacramento,California
<br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas
<br /> �[ rl 'f} 7, f. g. �,.q of t. is not required by Federal law.
<br /> WASTE MANIFEST
<br /> 3. Generators Name and Moiling Address M f N 1E-,R ( . ' E r I i C;: A. State Manifest Document Number
<br /> 42 ROTH RIDAr 236630&w�'j
<br /> ',�a i f,-l" FINANCE DM I N T n B.,St'to erierator's ID
<br /> LO A! 5..
<br /> 4.
<br /> Generator's Phone( .i)9)
<br /> cV 5. Transporter I Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved,]
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<br /> OE .0 E ` " K~ . N Sj ,.�C5. 1 1 e[s,,...,, .t...l,,,'�, _["I1:•t ?l. yr`{,
<br /> D Transporter's Phone 900
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<br /> 00 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved:]
<br /> f. Transporter's Phone _.
<br /> JV 9. De' P_ted Facility Name and Site Adflre s 1 '-a 10. US EPA ID Number G. State Focili 'SID
<br /> CA
<br /> SALIDA :A 91553F3A l t a:;S,6.1 3 Y 6 8 H. Facility's Phone
<br /> U_ 209 545-1011
<br /> .j= 12. Containers 13. Total 14. Unit
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<br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number(
<br /> V No. Type Quantity Wt/Vol I. Waste Number
<br /> JZ a. State
<br /> _ #.USED CLEANING, UNPO4 NDS, N. 0. 1 , Ell, N. Dili 134
<br /> LIGUID (NOT U DO"� �f� 5����±�� ]��i'� [ � 1 ��) � , .I � EPA/Other
<br /> 3 G r 11 �'fi.S PARTS WASHEER EER ,r�L1#..U'T MJl +. ;.�� d, �_' r s J
<br /> 64 o N b. State
<br /> co E EPA/Other
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<br /> EPA/Other
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<br /> State
<br /> Z EPA/Other
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<br /> N 1,Additional Descriptions for Materials Listed Above K. Handling Codes forWages Listed Above
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<br /> Z _I nst t nal retatio _ f s:.. ..
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<br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by per shipping name and are classified,packed,
<br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations.
<br /> J If I am a large uanti generator,I certify that I have a program in lace to reduce the volume and toxici of waste generated to the degree I have determined to be economical)
<br /> g 9 g h P Q P ty g d 9 y,
<br /> N practicable and that I ave selected the practicable method o treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health
<br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is
<br /> ad available to me and that I con afford.
<br /> OPrinted/Typed Name Signature " Month,/ aYe
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<br /> w T 17 Transporter I AcknovAedgement of Receipt of MaterialS
<br /> LU p Printed/Typed Nam gnature / o aY/'` eQ'
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<br /> W 0 18. Trans oiler 2 Acknowledgement of Receipt of Materials
<br /> ture Month Day Year
<br /> 0 R Printed/Typed Name Signa
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<br /> N E
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<br /> V 19. Discrepancy Indication Space
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<br /> f 20. Foci' ner or O er for Certification of receipt of hazardous materials cover6J by this manifest a ce t as noted in I _.
<br /> T Prince Typed Name q /r nai $ w ! ± oIth ., DbY(
<br /> Y .2 / fi°�,(� s°"p .. 4y� id'(
<br /> r DO NOT WRITE BELOW THIS LINE.
<br /> YelloWr TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS.
<br /> DTSC 8022A(1/99) (Generators who submit hazardous waste far transport out-of-state,
<br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within, 30 days.)
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