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5tate r California—Environmental Projection Agency ; <br /> Form At.,roved O eB No.2650-0039(Exoires 9.30-99; St?@ InStt'UCti0t15 Ott I;}t3C�4 O�PO� Department of Toxic Substances Contro' E <br /> Pieasc p ur.ar type. irorm ces�gned for vse an eine(12;oikh)wcawai.•ec Sacramento,CGlifornio <br /> { <br /> 1. Generator's US EPA ID No. Monifes!Document No. 22. Page'i Information in the shaded areas <br /> I UNIFORM HAZARDOUS is not required by Federal low. <br /> I WASTE MANIFEST <br /> ' I 1 i&J i 0 10 10 I ai <br /> I 3. Generators Nome and Mailing Address !A. Stole Manifest Document Number a, <br /> Prestige Stations,hi <br /> 6- State Ganeraior's ID <br /> <� P.0,Box 90M <br /> 7' 4, Generofors Phone 1 <br /> r. 110 7st7— , ) { I { { I { I <br /> cN 5. Transporter 1 Company Name 6, US EPA ID Number C. Staie.Transporter's ID IReserved.j <br /> h <br /> W --- <br /> EE D. Transporter's phone <br /> as ,- t iC�S,Z .._._.__.., r nl o I�J I, moo{ t Q1 F3 Q D 0 <br /> �U .{1 f1- —b. E�'A I:,Nu bar i <br /> E. State Tronsporter's IDY es`"e/ve j <br /> F. Transporter's Phone <br /> o Desionaled FacilifE Name and Site Address 10 US EPA ID Number G.State Facility`_ID <br /> <ZhoI <br /> ONTX Envirazne" <br /> i <br /> af 1704 West First St-ed H. Facilih/'s'Phone <br /> =i Amiss OA._9.1702 <br /> I I US DOT Description lincluding Proper Shipping Name,Hazard Class,and iD Number( 12. Containers 13, Total 14, Unit <br /> U i No, Type Ouar Wt/Vol 1. Waste Number I <br /> a <br /> _ H$zardan Waste,solid,rLo.s = state <br /> 152 <br /> ~t 9 NA3M7 P.G.IIIf� EPA/Other <br /> (nolA Ftprtrina) __ I 7A NOff, ` rlP T'MR <br /> o N b l State <br /> � E <br /> I I EPA/OFlier <br /> 4 R <br /> c A -- -- Ston. <br /> O, T i <br /> co I R i ( EPA/Other <br /> I <br /> w d State <br /> Z <br /> Lu <br /> V EPA/Other <br /> Lu <br /> V) i. Additional Descriptions for Materials Listed Abovc K. Handling Codes for Wastes Listed Above <br /> Z <br /> O 2M Nath AmericanEMMGENCY RESPONSE GUIDE N0. 171 b. <br /> uj <br /> Profile 4DD1360/480966 WZP# <br /> Q1� <br /> Oj i,: 1 S. Special Handling instructions and Additional Infornation <br /> a' AbscIrtwiFilteswith Gasoline. Weer appropriate protective P�� l f BESI#52730 <br /> Z cicttring. 2430 Gmaline Read <br /> I <br /> t <br /> (949)753-5$26(24 hax Emergency Phme) Trgcy,GA <br /> o. hf w the contents of this consianment are fully and accurately described above by proper shipping name and are classified,packed. <br /> marked,and labeled,and are in all respects in proper condition for transportby highway according to applicable international and national government regulations. <br /> V; <br /> I <br /> If I am a tare <br /> quantity generator.1 certify that I hove a rogram in lace to reduce the volume and toxicity of waste generated to the degree I have determined to be ecanamicoll <br /> 9 9 y 9 Y P P rY g 9 <br /> n practicable and that I(save selected the practicoble method GT freatmen1,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> n and the environment;OR,iI I am a small quantity generator,I have mado u good fcilh effort to minimize my waste generation and select the best woste management method that is <br /> aavailable to me and Ihot I can offord. <br /> ). Printed/Typed Nome Signafur Month Day Y l <br /> z ; Larry M 3=as of PSI_ t - <br /> l' tzw <br /> IR 17. 1ron4portet i Acknowledgemept of Receipt of Materials <br /> wPr ed; eo a _•^� Signature nth Day Year <br /> " ' l 71 � <br /> w' s <br /> p <br /> iransparter 2 Acknowledgement of Recetisl of Materials <br /> I T .I Printed/Typed Name Signature Month Day Year <br /> u.t l = <br /> c <br /> ;3 I <br /> V, 19. Discrepancy tndlcatlon Space <br /> F <br /> Z; A <br /> C ' <br /> l <br /> f ! 20. Facility Owner or Operator Certification of recei 1 of ha rdcus materiels covered by this manifest except as noted in Item . <br /> F T Printed orae Signature ' Month Day Yeor <br /> `T 0 NOT WRITE BELOW THIS LINE. <br /> s.. <br /> s z' <br /> IXC <br /> 8022A it/99i <br /> 'c"rA 8760-22 . <br />