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<br /> >tfefe Pivu 0-r type. For:,d..yned!er.0 on dib/IgarlA)Iyplrr r. se<remenu.G.Iaema
<br /> 1. Generales PA 10 No. Manlfed Doeamen,Ne. 2. C.g. 1 Inlorm9don:m!shaded erect, 1
<br /> UNIFORM HAZARDOUS 2 ;,no,oga;red by P.06,01 1.-.
<br /> WASTE MANIFEST 0-r
<br /> 1. Gerommr'f Nome and Mmlino Addren ,t A. SMe MfnIiTM DOCIlTea,Numbef
<br /> sr.76 5 Q.2T�Al2ra t 93188899
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<br /> C !. Transporter 1 Company Nome 6, US EPA ID Number C. State Trcnporfer'f 10 0
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<br /> o0-I D. Tronfport e%Phos! !
<br /> PETROLEUM RECYCLING CORP. �C AIT 10 8 0 0 1 1 0 5 9 800 874-4444
<br /> 7. Tremp.ner 2 C9mppny Name B, VS EPA 10 Number E. State Tmnfp9ne/r 10
<br /> 6
<br /> U F. Tro,„peMr i Mend
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<br /> C 9, Designated Facility Name and Sire Addrw. 10. US EPA 1D Number G. Shste Facility's ID
<br /> ' 0-r PRC PATTERSQN, INC. - CiAiD1018 3 16 6 7 2 8
<br /> .g 1,3331 N. HWX. 33 H. FodWf Phar.
<br /> <I PATTERSON, CA. 95363 C A n 0 8 3 1 6 6 7 2 8 800 874-4444
<br /> u 12. CTIM,1 u. Total u. umf
<br /> T) I1. US DOT Dwcdplwm hncluding Pepe,Shipping Nome,Haloed Class.and ID Number) N0. Tv Ouonti Wf.'Vol I L Waft Numhw,
<br /> a SON 223
<br /> 3I �. FPA/Other
<br /> I
<br /> NI E NON RCRA HAZARDOUS WASTE LIQUID 0 011 TIT Q Q. G
<br /> b. I State
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<br /> tvlR EPA/Oder
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<br /> U EPA/dMr
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<br /> z .l AdJdtmtai Desee'PtiwSs for Matwfalf tided Mow ,_.'•!„A ; f 'F2" 'Y C Nordling Coder iw Wadaf lis,ed A6ova
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<br /> 20 1s. Special Handling Instructions and Additional Inlonnaden•: �,. N
<br /> z 24 HIR. EMERGENCY CONTACT: PRC 111-(800)-874-4444
<br /> 24 HR, EMERGENCY RESPONSE: CHEM TEL INC. #1-(800)-255-3924 1
<br /> w' APPROPRIATE PROTECTIVE CLOTHING & RESPIRATOR.
<br /> 16. GENERATOR'S CERTIFICATION: I hereby declare mat me<omenn of the con,ignmmm We Wily and omrably described above by proper shipping name and ort dat.dfied.
<br /> Q pocked,marked•and labeled,anJ an l..0-R.e.pcJ.is N.apw eendFen ler h•enfped by high.%Pc,o,dh o 1n nppR,.hle fadnrol,slate and infernarional la..f.
<br /> V If 1 am o Jorge quantity ge",as., 1<.wly that, I have o program In plan to reduce the volume o Ad w.icit,61 .•o.te generated le me degroe I have daNrnw.d,P ke
<br /> �r econa.k.11y praedcoble end that 1 have selected me pra<dcabla method of treat...,,pto r e�mly_available to me rhich min.mlTn the P,4%6,end i.t".
<br /> a mnot to human heabh and m.environmem; OR, R 1 am o,maR gaantiy goner o,I llov made a Ped foim.Ty my wmfe generation and Select me hes,
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<br /> ..off.man emirs method that if ovaAable to rM and that I can olford.
<br /> 0 NW. /Typed No Slgnorwe I Month D%/
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<br /> ZT 17. T'amoorter 1 Ackoawied errfenf al Recei f of Material '
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<br /> ped ae 5igrwWrt omh % ePr
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<br /> 9 tR. nfoostr T Acknov+led ement of Receipt o/Materials
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<br /> y I , Printed/Typed Name, Signature Avonrh Di y Y.ar
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<br /> w 19. Discrepancy Indcmion SPoce
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<br /> 20, P.O;.Q.nw or O cn.r Cereficaien ofecd ,PI harardov. oferioli covered iliamonile,f ezce f 03 noted in Ilam I .
<br /> Primed/Typed Name Signature Men,h Day
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<br /> DO NOT WRITE BELOW THIS LINE.
<br /> whao: T501F ^Eric° Tl-! -
<br /> UISC 8022A 17/921 T,.: P.O. 00-, -3000.
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