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owerml Protection Agency <br /> - - -' Jo.2050-0039(Expires 930-94) See Instructions on back of p. 6. Department of Ts.ir soboarae,Cmtrol <br /> JForm desipmd For use on slier(12piech)ype'Alvr. "' Socrommto,California <br /> UNIFORM HAZARDOUS 1. Generatoo.r's US EPA ID NManifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST 6 C /L of not required by Federal law. <br /> 3 31 <br /> 3. Generator's Name and Mailing Address tj-�' C,S it�H S I' :Gr A 1,)I))4•N'f ( 7 ,x miser <br /> 2 � � U ry ( A-1 ,�', 577' -- ' <br /> rienermor's ID r <br /> ah <br /> A. Generates.Phone�( > 5 -i-v c/q vj C A <br /> d 5. Transporter 1 Company Nome 6. US EPA ID Number 'TwnsparSer's ID <br /> OP <br /> PETROLEUM RECYCLING CORP spoHer's Fhone CAT 0 8 0 0 1 1 0 5 800 874-4444 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number ,Transporter's ID - <br /> Q)V <br /> _'spooer'ePhone - <br /> QFa <br /> 9.Designated FacilityName and Sise Address 10. US EPA ID Number Facility's ID <br /> 00p PRC PATTERSON. INC. C A Di018 361617 2 ; "I <br /> 00!E: 13331 N. HWY. 33 y,Fhona. <br /> �{U PATTERSON, CA. 95363 ICIAID101813111616171218 '444' <br /> M 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unif <br /> �= No. T Quantity Wt/Vol waste <br /> a' State " <br /> ri E NON RCRA HAZARDOUS WASTE LIQUID 0 011 T G I EPA/Oih' <br /> m E <br /> C4 R %Otho <br /> ag T ' Sfote <br /> K R EPA/Other <br /> F <br /> Z d. <br /> U <br /> ZZ <br /> a <br /> i H <br /> W <br /> K <br /> Q <br /> 0 15. Special Handling Instructions and Additional Information <br /> Z 24 HR. EMERGENCY CONTACT: PRC C1—(800)-874-4444 <br /> 24 HR. EMERGENCY RESPONSE: CHEM TEL INC. O1-(800)-255-3924 <br /> W APPROPRIATE PROTECTIVE CLOTHING & RESPIRATOR. <br /> 1 F <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the consignment are fully and occuratvly described above by proper shipping name and are classified, <br /> ked,marked,and labeled,and are in all respects in proper cordilion for transport b highwayaccord; to applicable federal,state and international laws. <br /> V Pec Pe P Por Po Y rg PP <br /> If 1 am a large quantity generator, 1 certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimi.es the present and leisure <br /> throat to human health and the emiranmmts OR,D I am a ..If quantity generator, I hove made a good faith effort to minimize my waste generation and select the best <br /> N <br /> � waste management method that is available to ms and that I can afford. { • <br /> 0 Priml Pr' T d Na Sigratory <br /> Z T 17. Tran saner 1 Acknowled mem of Receiptof MaterialsW e <br /> Vr P' yped rmv Sigrature <br /> N nth t r <br /> w , <br /> F o 18. 11onsporter 2 Acknowle =Pf of Materials <br /> W e Printed Name <br /> 0 T /Typed Signature Momh Day Year <br /> 0 e <br /> H 19. Disampancy Indication Space <br /> Q F <br /> V A <br /> Z C <br /> I <br /> k <br /> 20. Fad' Owner or Operator Certification of rem; of hazardous materials covered b this manifest meta t as noted in Item 19. <br /> T Panted/Typed Name Signature Momh Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A (7/92) <br /> EPA 8700-22 Yellaw: GENERATOR RETAINS <br />