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Start of Coklomin--Envvanmentol Prosection Agency <br /> Form Approved OME No.2050-0039(Expires 9-3°94) `moi SeQ IOEfE1/Eflggg 4)A bgCle Of r• Department of Toxic Cold. . Control <br /> Ileaw print or yp.. to,.designed for uw a dih,(17�piKh)lypewnh,r. �."/ So<rameero.[alitame <br /> 1, Generator's US EPA ID No, Manifest Document No. 2. Page I Information in the shaded areas <br /> UNIFORM HAZARDOUS it act required by Federal law. <br /> WASTE MANIFEST C AND 9 8 0 18 1 5 2 5 12 3 1 9 7 1 3 of 1 <br /> 3. Genereter's Name and Mrs ng Address A. Style Manifest Document Number <br /> o SAN JOAQUIN COUNTY <br /> v L State Genre atar'ezID4 <br /> P. 0. Box 1810, Stockton, CA 95201 - <br /> e. Genllaku s Phan. (209)468-3066 <br /> S. Transporter 1 Company Norrs• 6. US EPA I°Nvmber C. Sine Trampore(s ID O /1 .I r,Til <br /> NOR CAL OIL A D 9 2 1 7 2 5 ° 7F"ap°ter's Flivions, (209) E674692 <br /> 7. Transporter 2 Company Name S. US EPA ID Number E. States Tromponet's ID <br /> <s <br /> UE Tronspoders Phone <br /> 7< esign <br /> 9. Dated e Facility,Namand Sit•Address 10. US EPA 10 Number G. State Facility's ID <br /> n PRC PATTERSON, INC. 1 <br /> 13331 N. Hwy 33 H. Focility'sPhora <br /> r)Q CAD 0181 3 1 6 6 7 211 <br /> PAtterson. CA (800) 874-4444 <br /> 12. Contoinen 1 13. Total Ie. Unit <br /> If. US DOT Description finclud'ssg Proper Shipping Nome,Hazard Class,and ID Number) No. T QuantityWt/Vol I. Wade Number <br /> I J <br /> Z223 <br /> A °' NON-RCRA HAZARDOUS WASTE LIQUID <br /> 3 G (WATER & OIL) 0 10 11 T IT p S G EPA/cher <br /> gEState <br /> 00 N Is. <br /> a? E <br /> , R EPA/Otho <br /> A <br /> T c State <br /> f EPA/dins . <br /> rc <br /> R <br /> W d State <br /> W <br /> U EPA/ix <br /> W <br /> N K. Handling Cada lar Wash tided Also. <br /> Z J. Additional Des<.iprlom for Molvids Listed Abe" <br /> N TANK, BOTTOM WASTE b. <br /> RINSATE ,,.^� t <br /> a d. <br /> 13. Special Handling Instructions and Additional Information <br /> APPROPRIATE PROTECTIVE CLOTHING site; Corral Hollow Sanitary <br /> <Z "EMERGENCY CONTACT: (1209) 667-6692" Landfill <br /> WSEE E.R.G. PAGE 31 Corral Hollow Rd. , & I-580, Tracy, CA <br /> x <br /> � 16. GENERATOR'S CERTIFICATION: I hereby dzdora that the canton"of this consignment on lolly and accurately described oboes by proper shipping name and are classified. <br /> 's packed.marked,and labeled,and are in all rospmts in proper condition for transport by highway according to applicable international and"&not government regulations, <br /> U <br /> If I am a large quantity genwracrr, I certify that I haw a program in plan to reduce the volume and toxicity of wash,generated to the degree I have determined to be <br /> economically practicable and shat I haw selected the practicable method of treatment,dorage,or dispersal currently available to me which minimizes the protein and future <br /> threat to human health and the enviramnant:OR, if 1 am a 1-11 quantity generator, I how, made a good faith effort to minimize my waste generafion and used the best <br /> wash m errant method that is available te me and that I can afford. <br /> Printed/Typed Name TC ar orpe agent <br /> Signature Meath Day Year <br /> L for San Joaquin Count 0 2 2 6 9 6 <br /> T 17. Trans mr 1 Ad"Aaclassamost of Receipt of Materials Y•or <br /> O N PrinMd/Typed Nam• Sgnatura MO^d' Dal' <br /> K s w 0 2 2 6 9 6• <br /> f a 15. Ymnstrarejer 2 Acknowledgement of Receipt of Materials <br /> Momh fay Year <br /> to i Primed/Typed Name r• <br /> LL 1 <br /> 0 • <br /> y+ 19. Discrepancy Indication Spot• <br /> V< Is <br /> U A <br /> Z_ I <br /> 20. FxJOwrwr r ruler CerSli<atio of renal t o asardou 'material c red b this manned exp t as nates isMissiles Do/19. Y <br /> T Printed/Typed Name Sigrotuw !' <br /> Y l <br /> DO N0"1KfE1ELWfHIS LINE. <br /> While. TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A. (9/93) to: P.O. Sox 3,00, Sacramento, CA Mill <br /> EPA 8700-21 <br />