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Ste4e of Cahfornio--EnvironmeMal Protection Agency See Instructions on back of page 6 Deportrrned of Toxic Subrtancos Canard <br /> Form Approv&j OMR No 2054-0039(E930-94) Sacramm o Coliforma <br /> Please print or type form designed for u on efts(12prrch)lypnvrrler Information m the shaded anal <br /> 1 Generator's US EPA ID No Manifest Dm <br /> ocuem No 2 Page 1 Federal law <br /> IF3 <br /> NIFORM HALO US is not reWited by WASTE MANIFE5TQ 1A <br /> nerator s Name and Mailing Address SERVE PETROLEUM `A _ <br /> 10704) North Freeway Suite grin Houston Texas 7703" P5-. s 4y. <br /> 4 Generators Phone %o o) 3618-61")1 ext '�5 f•, '` � s _ <br /> 00 00 6 US EPA ID Number SfttRe^T�; . <br /> S Transporter 1 Company Name s crx 40 <br /> s IIaefr < .s, " <br /> Go <br /> H A H 9147' BRRVTf V r'OHPANY k 17 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number <br /> VTjaixpo!teT's Pltatie '` <br /> 9 Designated Facility Name and Sim Address 10 US EPA ID Number SIo4e FpdNE�t lD a v„ <br /> 0 2 8XRV T ME -VKPANY - «� <br />�p 1?" Terry A PranCc in Street Is"WHO <br />�q� girt FIAucIAcn 1'A 441(t7 ) <br /> i/Q 13 Tota! 14 Unit <br /> V 12 Caritarners of 1�tiM <br /> 1e'�Z 11 US DOT Description(including Proper Shipping Name Haze <br /> rd Class and ID Number) T C]u /V <br /> V= <br />%& &L A111) WATER <br /> G <br /> WM- CRA HAZARDOUS BASTE LIQU11), T IT 0173 3 � <br /> E <br /> r <br /> i <br /> C? N br <br /> of <br /> N R RA <br /> �i A i y <br /> T <br /> C> . <br /> aIL O <br /> IM R <br /> W <br /> I.- ds t <br /> Z <br /> R 1 <br /> U.1 <br /> V <br /> rR �f$apoling C",edee fair Wadee f <br /> 3 Adddronot Dowt Note for MAsoriaki Wed A6orr'VM, OIL AM WffM <br /> A r <br /> h <br /> Z <br /> 0 15 Special Handling Instructions anm <br /> d Additional Information <br /> JOB #12242 <br /> 30f1 SITE it-Z SIIRVE STATION, 31r?f)9f 5 <br /> Z 24 lir %merQancV Cont Act • H H !( 41 5) S43-4815 2537 Hater Loo toad <br /> LU APPR0PRTATF PR1LWEr"TTVE ("L(ffHTV0 AND RFSPTRATOR Stockton , `&Iifornia <br /> I-. described above b proper shippingname and are classified <br /> J 16 GENERATOR'S CERTIFICATION 1 hereby deckare that the cordents of the consngnmernt aro fully according a livable federal by <br /> and mterrratraial kaws <br /> Q pocked marked and labeled acrd are in all respects in proper condition for transport by highway >p pP <br /> V of waste rated to the degree I have determined to be <br /> If I am a large quantity generator I certify that I have a program in place ro reduce the volume and toxciay availobb to me whish mmimizas tle presets and future <br /> economically practicable and Mat 1 have selected the practicable instead of treatment storage or disposal rrsritly <br /> a shse&to human health and the ennironmert,OR d I am a smell quordity generator I hwe madena goodifoA effort to minimize my waste genesatron acrd sakact the best <br /> r <br /> waste <br /> management mat�nod Mat a available ro me and Math can afford 'r Month Day Year <br /> Q Panted/Typed NameTe o 3 5 3 <br /> r <br /> TIiTE Al.l.E14 MAC MNATA) <br /> VT 17 Transporter 1 Acknwwled of Recce of Mate ciDay- Yews <br /> = e Pn <br /> Signature- i `i 0 !? � <br /> °C s <br /> W <br /> 0 18 Transporter 2 AcknoWled0@11101911 of Rempt of Mistenah Meeh Day Year <br /> i Pnnted/Typed Nome <br /> U_ S,ynafuro <br /> 0 i <br /> N19 Discrepancy lndicolwn Space <br /> V p <br /> Z C <br /> I <br /> L <br /> 1 2D Fadi Owner or °tor Certihcahon of racer of hazardous materwls covered Mis manifest axc as noted m Rem 1 Month DW Yew <br /> T Printed/Typed Name $ignnatniro <br /> Y <br /> DO NOT WRITE BELOW THIS UNE <br /> DTSC 8022A (12/91) Yellow GENERATOR RETAINS <br /> EPA 8700-22 <br />