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State of California—Environmental Protection Agency - <br /> For Print <br /> OMB No.2050h0039(Expirts 9.30-99) <br /> Please pnm - See Instructions on back ',19e 6. Department of Toxic Substances can,, <br /> q.type. form designed for we on elite(II-p�`�. ewritec Sccramemo,California <br /> UNIFORM, HAZARDOUS I Generator's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br /> [ is not required by Federal law. <br /> WASTE,MANIFEST 5 '� a e{ of 'p <br /> 3. Generator's Name and Moiling Address A. Slate Manifest Document Number 23812533/� Q 1 2 Y 3 3 <br /> 1t11..ICON ILLI2N7KEY, t;01,011UN!:; - - L J Q <br /> 0 4INl INDLIZiTf1J1111-PAW DRIVE MAN 1'I---.CA.C& Wrj-1 3. State Generator's ID <br /> A. Generator's Phone 1 2W1-'2" 7 3 ruI71, AHNIOO KAMAI <br /> N 5. Transporter 1 Company Name <br /> h 6. US EPA ID Number C. Stale Ironsportei s ID[Resarved.J <br /> CK) I;amos EErvlr'unrrrerrtal Services P 4 11 3 6 6 D. Tronsportees Phone �.,e.+ 7,'-57$p <br /> o V <br /> 7. om an Transporter 2 CN <br /> P Company 8. Us EPA ID Number .E. stab Tronsportels ID IResarved.J <br /> M Q F. Transporter',Phone <br /> ih V yy Designated Focili Name and S- .,sddreu 10. US EPA ID Number G. Sci'y ID <br /> LO-le Aanu s R_nvw ninfenial .,ervtoes te Q Lfs _ <br /> 2 1515 S. River Rd. N. Facility's Phone <br /> s 1 o W. Sacramento, Ca. 95691 944003566 916-371-5747 <br /> Q 11. US DOT Description 12. Containers 13. Total 14. Unit - <br /> m V p (including Proper shipping Name,Hazard Class,and ID Number) No. i e Quantity Wt/Vol I t umber - <br /> State <br /> N= Coinbldsiible Liquid, N.O.S., NA1993, KAU <br /> 3 c (used oil) ERU'DQ 12£S [01 ITEPA/ah:r,N <br /> E o <br /> N b. slots <br /> m E <br /> 'V R FPA/Other <br /> v A <br /> 0o T ` <br /> State <br /> m O <br /> _ R - EPA/Other <br /> F d. State <br /> Z <br /> w <br /> V EPA/Other - <br /> w <br /> J. Additional Descriptions for Materials Listed Above - K. Handl g .du(Waste Listed Above <br /> Z (lick , 1K55603-c t) Is. <br /> d. <br /> a <br /> Z F'iv.Seeci�Fl:ro.ltgrcnet .i,ional Information <br /> � IVVLLf1LL [J tCSCC. <br /> Z 24 HP.. EMERGENCY CONTACT: 916-371-5747 Job# Profile* <br /> i00INDUSTRIAL PARK DPPRJE, MANTECA, CA., J <br /> 76. GENERATOR'S CERTIFICAnots: I hereby declare that the contents of this tonsil ent are fully and accurately described abby proper shipping name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition far transport by highway according to appliove cable international and national government regulations. <br /> If I am a large quontiry generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economical <br /> hpracticable and that I hme selected the practicable method aF treatment,storage or disposal currently available to me which minimizes the present and future threat to human heal <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort W-minimi my waste generation and select the best waste management method that is <br /> ad O available to me and that I can afford. <br /> >- Prim /Ty ad Name signa"furs !F Month Day Ywr <br /> Z /x MAI) r-AMAL- a S I Z v A <br /> T 17. Tra- rter.I Acknowled'ement of Receipt of Materiols <br /> W A Printed typed Namesigns Month Day year, <br /> W P B o6, G o.✓G� oY, 6 5 / a ct <br /> 8 18. Trans iter 2 Acknowled ement of Recei t of Materiab <br /> O T Printed/Typed Name SignaNre Montt Day Year <br /> W E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> _ q <br /> C <br /> E <br /> I 20r-Sacilily Owner or Operator Certification of receipt of hozord s materials covered this ifest eaa t as noted in Item 19. <br /> TP tnted/T Name�� � ` 'yam Signature Mon Da� Yaor <br /> xf 051 <br /> DO NOT WRITE BE HIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) (Generators who submit hazardous wait. For transport out-of-slate, <br /> EPA W00-22 <br /> produce completed copy of this copy and send to DTSC within 30 days.J <br /> ' <br />