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"0 Of Cal –Heats and Welfare Agency Department of Realth Services <br />Form Approved OW No. 2050-0039 (fires 9-30-91) See Inshudlons on back of page 6. Toxic 9"ances Castrol Program <br />*1100OVaa type. Form devgned for we on elite (12 -pitch typewriter). Sacramento, California <br />UNIFORM HAZARDOUS <br />1. Generators US EPA ID No. <br />MonVest Document No. 2. Page I <br />Infoffnation in the Oxxied cleas <br />— WASTE MANIFEST <br />cl Al �Ll 21 F, 11 41 <br />1 Of <br />Is not iscluked by Federal law. <br />3 Generators mmm and Mailing Address <br />^7- <br />ale: <br />3n <br />.. ...... .... <br />* Generator's Phone <br />Sr <br />.......... X <br />* Transporter I Company Nana <br />EPA ID Number <br />4V 1*t. <br />A. <br />.......... <br />PKC 1i CRC', INC. <br />19 11 16 <br />L9 <br />7. Trareporter 2 Componj Narne <br />8 6 EPA ID NumberX....... <br />X , <br />... .......... ... <br />r. �V,"UleO rMETY Marne QrX3 We ACICIFOSS 10. US EPA ID Number <br />PATTEkSO" INC. <br />PP.TTERSCN, CA 95363 C A iLi 0 6 0 <br />11. US DOT Description (including Proper Shipping None, Hazard Class, and ID Number) <br />G <br />E <br />N <br />E <br />R <br />A <br />T C. <br />0 <br />R <br />Contahers I& Totd 14. Unit <br />I& VOC101 "laing Instructions and Additional Infognallonrr,q" - -- - . .. ....... . ... .... .. .. <br />,v <br />i.4 RK. L14LR6LNCY CONJACI: PRC 1-300-674-4444 MAR 0 6 1992 <br />k4 hF, &'LkGfNGY C(j%TACI*, CPEX TEL i',;C. <br />'C. I-efiJO-k55-392-4 ENVIRONIMIEN, <br />AppboO"I <br />p�JA7E' PF'VICTIVI, Ci.(;TNT=,G & FESPIRATOR <br />pocked. ffxxkecL aid loWed, and are In all respects closiftid, <br />16. GENERATORS CEOFr–ATK)t+ I herebY decime that ft contents of this consignment are fully and accuratW described above by proper sfifppij and <br />In proper condition for transport by hWwvaV according to applicable intemational and national goverment regulations. <br />9 1 am a large quantity generator. I cer* that I have a program In place to reduce the volurne and toxicity of wade generated to the degree I have date"Ined to be <br />econorrk-4* practicable and ffx# I have selected the piaebodbW trothod of tmcWnent, storage. or disposal currently available to me which minirntzes the present aid future <br />t1veat to human health and the environment. OR. r I am a mXA qumft generator. I tx7ve rnade a good faith effort to ff**nlze MY waste generation and select Itm best waste <br />rnarvcgemard method that Is a-x*cbb to me and that I can afford. <br />T 17. Transporter 1 Acknowledgement of Receipt ofMale <br />A R P*ftcVryped Rxne <br />N <br />S <br />P <br />0 18. Transporter 2 Acknowle 4 ofSet! Of Male <br />R Printed/Typed Nan® <br />T <br />E <br />R <br />F 19. Discrepancy indication Space <br />A <br />C <br />I <br />L <br />1 20. Facility Owner or Operator Cerlificallon of receipt of <br />T Printed/Typed Name <br />K-3 <br />LJV NVI WKII 1: DUVW I M13 UNE. <br />DHS 80M (12/90) Yellow: GENERATOR RETAINS <br />