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C <br />LL <br />all <br />' a <br />1� <br />I � <br />F <br />17 <br />m <br />a <br />m <br />a <br />W <br />Z <br />Z <br />U <br />W <br />Z <br />0 <br />Q.N <br />I W <br />t` W <br />a <br />t 0 <br />l1— <br />Z <br />— <br />Z <br />z <br />W <br />I <br />i U <br />r <br />I <br />I y <br />K <br />0 <br />Z <br />W <br />�. rc <br />• W <br />i <br />W <br />i 0 <br />! W <br />W <br />U <br />VA <br />P-ceived Cam Pee" 411)31q� <br />--------------- ------- <br />Pm" <br />------- `'— ---- —----- <br />s'6 mho--Envirp�memal Protection Agwscy ' <br />OMB No. 2050-0039 (Expires 9.369d( See Instructions on back of p e�6. Depanm �cl5uhamce. camoi <br />o or type. Form desamd yo. use on elite /I2-ni ) vo l ! l.i L .. <br />HAZARDOUS <br />1. Generators US EPA ID No. Mousiest Document Na. 2. Page 1 Information in the shaded areas <br />- MANIFEST <br />y a not required by Federal low. <br />/? 3 ' � 1 .., h C � i �cf � y Pi l 2: 11 <br />JID <br />3e and Mailing Address <br />fC�r�r's <br />4e ( �j' - i5mpanhy <br />Name 6. US EPA ID Number <br />to Tmnt(Mrtr; !U <br />PRC PATTERSON, INC <br />v sI orfer'z Phone t Irl 7 du <br />1 I 1 1 <br />7. Transporter 2 Comparry Name 8. US EPA ID Number <br />Tronsportees ID <br />o <br />spotah Phaie ' <br />y, <br />9. Desigrated Feciliy Name and Site Address 10. US EPA ID Number <br />t{ <br />to Facflily's ID <br />PRC PATTERSON,ItiC <br />13331 N. hWY 33 <br />PATTF.RSON,CA 95363-9995 <br />11. US DOT Description Iimudtn Proper Shipping Name, Hazard Class, and ID Number 12. Contmhmn <br />13. Total <br />14. Unit <br />Ie <br />Wt/vol 'Wass. Num <br />a. <br />223 <br />G <br />?VON RCRA HAZARDOUS WASTE LIQUID L I <br />T <br />� <br />A/Other <br />T <br />y <br />G <br />N <br />Is. <br />E <br />R <br />n/ <br />N <br />T <br />C. <br />O <br />R <br />d. <br />15. Special Handling Instructions and Additional Information <br />24'HR. EMERGENCY CONTACT: PRC O1-(800)-874-4444 <br />24 HR. EMERGENCY RESPONSE: CHEM TEL INC. i1-(800)-255-3924 r ',_ •^r.. � ���`` <br />APPROPRIATE PROTECTIVE CLOTHING 6 RESPIRATOR. <br />S ?Vine k.J <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the convents of the consignment are fully and accurately described above by proper shipping name and are classified, <br />packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable federal, tote and international laws. <br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have delermine'rt <br />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the an ` <br />threat to human health and the environment; OR, 8 I am a small quantity generator, I have made a goad faith effort to minimae my waste generation and iiFee <br />wate management method that is available to me and that I can afford. 1 <br />Prinhd/T Name <br />Signature <br />Mantle, <br />-( <br />I Win <br />T <br />17. Tran enter 1 Aekn .led menf o} Recei f of %Aateriah <br />I <br />N <br />Printed/Ty d Na .. <br />Signature " <br />omit (��YUa <br />r <br />W f- <br />P <br />0 <br />18. Tromp!enter Acknowled .menti of Recei of Materiab <br />TPrinted/Typed <br />Name <br />Signature <br />Monts Day Year <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />I <br />I20. <br />Facility Owner or tion raCertification of receipt of hazard.. materials covered by this manifest ens as noted in b 19. <br />T <br />Printed/Typed Name Signature %Month <br />Day Year <br />Y <br />j <br />lzllrl <br />a E ij 2f 91 <br />s Y t h I S -'- r'i`n—Qil�ti'� <br />DO NOT WRITE BELOW THIS UNE. <br />