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Slaw of Califemio--EmaanmeNel Malec ion Agency <br /> Form Approved OMB No.2050.0019(Expire 9-3694) See Instructions on backge 6. Department of Taus Suboances Camra <br /> Pleae prvt or type. Fam,designedfar w an.Ae(12pi (IImMe. Sacramento,CaRlw,ia <br /> UNIFORM HAZARDOUS Cererrte/a US EPA 10 No. Manifmle <br /> est Document No. 2. Page 1 Information the shaded arem <br /> WASTE MANIFEST U �l h not required by Fede al o <br /> (J of <br /> 3. fxrorao/c Name and Moiling Address 5 D p I `T <br /> _R �O7 C N /01` M �O AIV P <br /> n 4. Generala's Phone S I v�G� 44 SZ O <br /> j, 5. Transporter I.Compwry Name 6. US EPA ID Number <br /> rp <br /> 7. Tromperter 2 Campo"Nana 8. US EPA ID Number <br /> Q <br /> U <br /> Q 9. Designated Facility Name and Site Address 1Q US EPA ID Number <br /> W �r AW �arj�vs zHelr <br /> 13331 N. RWY. 33 / <br /> a PATTERS CA, 95363 1 Cl A J 01 81 31 11 61 6 71 :2a[ <br /> V 12. Catak,em 13. Total 14. Unit <br /> Z it. Us DOT Description(esdudmg Proper Shipping Nana,Hazard Class,and ID Number) No. T wt/vol <br /> = a. <br /> H <br /> 3 G NO RC(� HAZARDO WA T <br /> c: E Petroleum HecycIing'doF' ' int °deifies that the anove <br /> N vaste S , more SpeCITICally l en yrice to the Wd we <br /> "t E 't forth above, Was were recycled in accord nce itft <br /> R <br /> A provisio s of 40CFR261.6 and 23.4 pursuant to 400F$2§1 ( ) <br /> T ,2j-hazardous waste generated from the recycling effo s was aler. <br /> R recycled in accordance with the provision of 40CFR266 Su D. <br /> W <br /> Z d. <br /> N BY Jit <br /> Z <br /> 0 <br /> a <br /> N <br /> K <br /> Z <br /> 0 15. Special Handling Inshuctiau and Additional Information <br /> 24 HR. EMERGENCY CONTACT: PRC #1-(800)-874-4444 <br /> Z 24 HR. EMERGENCY RESPONSE: CHEM TEL INC. 31-(800).-255-3924 <br /> = APPROPRIATE PROTECTIVE CLOTHING & RESPIRATOR. <br /> t- <br /> 16. GENERATOR'S CIRTIFICATION: I hereby d«hre that the content of the canegnment aro fully and«curately decried oboe by proper shipping name and are cleaned, <br /> Q pocked,marked,and labeled,and are in ag respects in proper condition for transport by highwry according ho applicable federal,stale and International hes. <br /> U <br /> H I an o longe quantity generator,I certify that 1 hoe o program in place and Msidly d waste generated b the depnea 1 have deMm'eed to he <br /> 1 econanicallf practicable and that I have selected to practicable method of V=101:: ,or disposal curmMly available ro me which minimims to preaenl and falune <br /> yt threat to human health ad to emirameary OR, H 1 an a small quantity . I a good fab,effort to minimha my walla generation and select to bet <br /> wagemanagement method that h avaihble to me od That f con afford. <br /> OV uPnmed/Ty Name 7nn (../.J <br /> Z T 17. Tra rte; I AcGwwkmjemeea of Receipt of Mawioh <br /> W e — <br /> V, A Pri me Signature Day r <br /> W a <br /> 01 <br /> e <br /> 0 18. rat r 2 Acknowled of R«a at Mabriah <br /> W T Nimed/Typd Name Signature M rdh" DayYear <br /> O : <br /> W 19. Discrepancy Indication Space <br /> W <br /> UF <br /> A <br /> Z C <br /> — 1 <br /> L <br /> 1 20. Facility Owner or 0aerclor Certification of receipt of Ismordous motedate ve <br /> cored In,Man <br /> ie mliest.'"t m <br /> as ndad M 9. <br /> TPrinted/Typird Month Day year <br /> r <br /> Sig <br /> D � <br /> DO NOT RITE 161O THIS UNE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (7/92) (Generators who submit hazardous wade for transport eato4�laro, <br /> EPA 8700-22 produce ompleted copy of this copy and sed to DTSC within 30 days.) <br />