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State a/CoHomlp—Ermronmneol Protection Agency <br /> Fon,Approved OMB No.2050-0039(Experm 9.30.94 See Instructions ON Page 6. D",r n,u of To.k Substances Cart <br /> iPlease pr.n w type. Fern,alm Bred for vse on elft/ 1 typewriter. Sacramento.California <br /> UNIFORM HAZARDOUS Generator's US EPA ID No. Manifest Document Na. 2. Page 1 Information m the shaded areas <br /> b not required by Federal Imv. <br /> i WASTE MANIFEST CAC 0 0 0 8 8 8 0 9 6 01 41 51 1 8 °f 1 _ <br /> t3. Generwoi s None and"aging Address gate Almdnl <br /> THERESA K. -MARLP.R ` z <br /> 93600192 <br /> 540 N. SANTA CRUZ #123, LOS GATOS, CA. 95030 ii:5tatecamaa's1D <br /> W 4 ce <rat° "°^e (408) 395-3991 <br /> 9 5. Transporter 1 Company Name 6. US EPA ID Number C. State T r(p Z <br /> m I PETROLEUM RECYCLING CORP. AAT 10 18 10 10 11 11 10 15 9 D. T 892-6742 <br /> 7. Trans rt,2 <br /> Po Conpony,Name R. VS EPA ID Number :E. Stake Trampa,le/s b ' <br /> U <br /> F. Tratsportees Phone - - <br /> • N Q 9. Desi g Facility Name arsd Site Address 10.1 US EPA ID Number G. SbM Facility's ID ,t <br /> W I P PATTERSON c e D o 8 3 1 6 6 7 2 <br /> u. T3331 N. HWY 33 H. Facrny's Phare <br /> a PATTERSON, CA. 95363 1C AID 10 18 13 11 16 16 17 12 18 209 892-6742 <br /> G U 12. Containers 13. Total 14. Unit <br /> Z 11, US DOT Description(incksdng Proper Shipping Name,Hazard Cksss,and ID Number) No. T Quantity Wt/Vol .L Waste Number <br /> s2-• °' :State-3;;:.-: <br /> -3 OIL, WATER NON RCRA HAZARDOUS L_QUID l <br /> O 01y G EPA/ <br /> l; TT G <br /> m N It - Stat <br /> a E <br /> R EPA/Other .. <br /> A <br /> T <. State <br /> o C- <br /> "i <br /> R EPA/011e. <br /> F <br /> Z I d' [E7PA1'0*,- <br /> UU _ <br /> Z A Additional far Materials listed Above <br /> O <br /> K Handling Codes for Wastes Usled Above <br /> K <br /> a d <br /> Z <br /> Z 15. Special Handling Instructions and Additional Information <br /> l 24 HR LXERGENCY CONTACT: PRC PATTERSON (800) 874-4444 <br /> Z 24 HR EMERGENCY RESPONSE: CHEM TEL, INC. (800) 255-3914 <br /> = i WEAR APPROPRIATE PROTECTIVE CLOTIHING AND RESPIRATOR <br /> t— <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the caresses of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q <br /> packed,marked,and labeled,and are in all respects in proper cmdaion for transport by highway according to applicable international and national government regulations. <br /> U <br /> If I am a large quantity generator, I certify Mat I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be <br /> J I economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and f rturl <br /> Nthreat to human health and the environment;OR, R 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste mann ement method that is available to we and that I can offwd. <br /> 0 P6.ttepV/Typed Name IC,1- I !- (: -. .� Signatv a t'G Month Day Year <br /> r ..lAk-6> I ..i6k.i;% 61 '6 FVLCfJYIC,�, ?�Ief.-S-<. jj4IGt.J(l � � <br /> U T 17 r sporter I Acknowleckiterownst of Receipt of Materials <br /> (J w Pn / ped Name / Momh Day Year <br /> �r�i. Al , Lia , c- ! r k� cf I/ <br /> W , <br /> o 18. Tram iter 2 Ackrawled ment of Receipt of Matruh <br /> ed <br /> W 7 Prim /Typed Name Sgnaturc ( Month Day Year <br /> u6 E �: <br /> W 19. Discrepancy Indication Space <br /> Vf F <br /> U A <br /> Z I <br /> — l <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed/Typed Name�Sigrvtre Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. t <br /> DTSC FORA (9/93) Yellow: GENERATOR RETAINS <br /> EPA 8700--22 <br />