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51ote of-ali6nnia—Environmental Protection Agency Control <br /> Form App ed OMB .2050-0039(E9p l t'9 30-991 - See IfIStrUCf1005 OD OC O )/C9@ Daporhnent a1 Toxic Su stanm <br /> Plea•RQJ ret r ype 'yorm designed for use on eo(12 pitch)tyr 'ter.- Sacrament,California <br /> UNIFORM HAZARDOUS 1 �..0 o.,S US EPA-ID'Na Manifest Document IRoa� 2.'Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> iu,tsr WASTE M%1WEST" 2 11 0 ? 9 1 2 of <br /> mf s fl Mail ng Address - t Daum f N <br /> 3. Gmmru h r t <br /> ¢.>2 d DY.-1TTc. 2 41055 <br /> r.'i.-S,TA24,zSe((l��tit9dr5tu St. - SroieG n r�torsld <br /> .sn LuCi h4'1y� <br /> Ge�ernmi' Hans 1N 35S 'fl'!1 AttnT Dana Allen <br /> M 5 Transporter T'Com rry'Notrre 9. - 6. US EPA ID Number C State Tron p t si1)IR%rved.I <br /> D Traosp ter s PhWo <br /> mil s: *slelax O w- t tr 9vakt U-8 8 D 8D0-326-1DZ1 <br /> 7 2 CIgnp8Ry 8-USTPA UNiR tmi— s1Ere T?. K cl-alefFID[R'eser'Kad)' <br /> AsrE rImms To sE smoPPE .,... . -51. .. , ,v+4Kgni - <br /> F'' nsporte v ne <br /> 9 r ated.FScdi Name and Site Addreu, � 1TTrT US EPA IID N. _ r.. G StateFoci sID <br /> - O L6.L'(3D�ar I <br /> 11855 White Rack Po" ;H Fac y5 Phone <br /> `»`�t'F 4 o Cordova. 35"7 '. 8 0 8 8 4 1 8 3 �-- <br /> ',O 916 351 0980 <br /> 12 Conbmeis"4 013.Total 14. Ue4. It <br /> 1 I US"DOT Description I'ncludt P r ShipptrSg,Nama,Ha 0mrd CIasP,and ID Nufn-l7yF w q, <br /> e�t�pn v°,C•, . wei6Gc+- No. $ It Wti vol 1. Waste Number <br /> Z J - State. <br /> RQ, Paste Flammable liquids, n•o.s.e 31 ON1J93,. 212 <br /> 3 G FE II (zyleue, D035) (F003, £005) EPA/Othar <br /> 01 011 '!DM 0' D 4 d' 0 P F005 <br /> o N Waa-RCRA hazardous waste solid (oily rags 6 352 <br /> R d6bria) 0 0 } D F 0 Q 2 0 P other <br /> -a . A <br /> T C. <br /> - <br /> o <br /> d .. <br /> .0 other <br /> y e "� '' K Hdndl'ng Codes far Wastes i'ited-Above <br /> Q rr $l.tyi <br /> b. <br /> N <br /> W <br /> 'R CEIVED <br /> z ,s.67a�ICaOae1-(a0r1T° 3L �1 — JAIL 112005 <br /> < <br /> Site 13, SOD M212 - - <br /> z BAN JOAQUIN COUNTY <br /> s OFFICE OF EMERGENCY BERWCEB <br /> F <br /> 16. GENERATOR'S CERTKICATION: I hereby declare than Iha conlenh of dtts consignment an fully and accurately describedabove by prow ship im;name and are clmsified,packed, <br /> marked,andlabeW,and an in all respects in Proper condition for transport by highway according to applicable international and naticraPgovern Bent rogulaaons. <br /> If t am a large 9aanb generator I certify dtaf I have a prog min Place b radon the volume and roxiay of wast generated ro the degree bma determined to be economically <br /> d prachcobl �p�Baa fl have salede0"�d,,tt�'s� cable mit" 1 treamientarorage,or disposal nrmotly dvoiI66I4 b fine-which imizis�present and-future threat t'human liealHS <br /> and die'erNmoStrRenM aR:tf`I bm:.t1',1p5a n lljK a.mutmor,I have toad.a goad faidt,eRart b m nrmtza my wase ganerpt n and'relect The best wo,Iq......ameat method-Lot is <br /> !7 available to me annd[d that I can afford. <br /> Z PrntedlT NPc�M e,�-rtf(r1= ! : Signature - _Month- Ddy _ Year <br /> /6 [ / III <br /> V <br /> W T 17. Tran r 1 Acknowl ement of Receipt of Materiab <br /> W /sd/Typed Nams - S� _ th <br /> x R rho ! :--: <br /> W S <br /> W 1&17 0 <br /> 1 IE. Trans 2 Acknowledgement of Receialt of.Materials <br /> O IT Phnted/Typed Noma Signature Month Day Year <br /> 19. Disdrepdnrylndicalian Space <br /> Z A _. <br /> car.. ,..d.. <br /> 1 20. Facility Owner 0,Operokt,Cerfification of rani of hazardous materials covered dti nanil nn as noted to Item W. _ . <br /> ._ - Signature . :...yfenlh Day Year, <br /> T, �prksned%'fyped Naiiw`- .__- _. . <br /> Y <br /> DO NOT WRITE BELOW THIS-LINE. 4 <br /> D=8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 - <br />