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•�,xW Ira ,"sawn•"rqweenerrraIrl-PIrGnIYPerwIfNF 11" •rr'e.1PATR" •" <br /> UNIFORM HAZARDOUS 1 "raters US EPA W No. cumene Poo 4 " M igin"Ji"WVM abaA11A � <br /> WAST MANIFEST Document No. la pot required by Federal law. <br /> ' 1 I 'LI I �lil rl -•I tnIlJ <br /> 3. Generator'a NhzsqAaidf1M40ing Adults" A. Iplele I ►t t Nu ' <br /> 6. Transposer 1 Company Name B. US EPA ID Number C. Stals Tfenoponitee 03 <br /> A 111 ted Pe t ro l tauwr IC IA t) 1918 IU Ib 17 Iti ji I.0 16 D noGiNt"pr'e P.bass <br /> N <br /> 'n 7. Tone n r2 CTPa �e S. US EPA ID Number E. Stote'TIMnlpWleral{)' <br /> m <br /> $ / ^ F. Tropsp%jor's Mm <br /> m <br /> B. Designated Facility Name and Site Address 10. S EPA ID Number Q• 04to 11011111y,019ry <br /> knfliter ies yervice C' N`D 0 li 13' 14 7 I&I <br /> 13331 it #iWY 33 Patterson " FMwlur'+I:.� ' ' , <br /> 3 < L A y i3o3it C A D U 3 1 o e 71213 <br /> _ Z <br /> r� 12. Containers IS. Tout 1M:'; <br /> a 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) y.Queltllly r`. that, J�ylYaY�',IIg.' <br /> No. Type WI/Vol "�TT 1dFF <br /> a. <br /> If Z G +urM FUEL 1:O("TIALE LIQUID <br /> E i" hA 1993 I T T G <br /> E b. <br /> t. A <br /> T <br /> wv O <br /> v q <br /> C. <br /> '•'W <br /> d <br /> W <br /> U <br /> w <br /> Z J. Mdltgnel Daecriptlone la Matorlale Lill{W Above K. HINIO 4M1 ,NYTe11 <br /> Vs-4 weiTEB AW It4"T4 <br /> [9 r <br /> m <br /> w STC FUEL <br /> O <br /> 15. Special Handling Instructions and Additional information <br /> Z U54 APPR&RIATE JOROTECTIYE GEe47 - <br /> J"IWATEU FACILITY EN"I iNCY CUi1TACT r (joU)474'444A <br /> ikhLAATJR E)1ERl iENCY CWTACT 4, - <br /> e. fir <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described ayanl'F by proper shipping name <br /> and are classified.Packed,marked.and labeerne �T <br /> log,and e In all reepecta in proper condition for Ire <br /> pon by highway gwding ag"0oF�1 �fPM PJ gd <br /> W national government regulations. ., <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 1x'14 dografl I he"Qelarmined <br /> to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal cnrriontly availobryle Ia me 11hpif mirtmiaoit Ina <br /> " E! <br /> present and future threat to humhealth end the environment;OR,It 1 am a email quantity generator,I have mope,a ygpf'IMIfia r <br /> Y )g Ta <br /> = generation and select the beet w ole IlNnepernenl method that is available to me and that I can allgrd- n <br /> 1y Printed/Typed Name 8ignatureyear <br /> , <br /> uc— <br /> Icy R 17. Transporter I Ac.0tnowledgement 01 Receipt of Materials y' '• - l ,� ,, <br /> 1S1 A PrinledlTyped Name , Signature Year <br /> N <br /> w O 18. Transposer 2 Acknowledgement Y Reeatpt of Materiels <br /> 7. Printed/TY a Nsme Signature err: N YostZ E r 1' ;! I' <br /> Ig. Dlecr ency Ind at psc <br /> .x4L.i.. <br /> C x . <br /> 1 k <br /> L +Y <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as nosed IA Ilam tg. <br /> T Prinl d/TYVed Nam ^ Sipnatun ,Y " pypr�rA . ,pe..y Year <br /> i <br /> DNS 5422 A 11 1110) rr „ <br /> EPA BTO!}-22 -' Do Not Write Below This Line 11 -'� w <br /> (Rev. -N)Previous iuons ere obsolete. <br /> GRAN 4jAPI, R RETAINS <br />