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State atoaff°mia—Envir°nmemel Protection A9en<y �r <br /> Form Approved OMB Na.2050-0D39(Ezpbes 9-30-96) See Instructions On back nage 6. Depanmem of T..ic Suba ma.Cnmro. <br /> Please print or type. -Form designed for use on elite(129ird .-river. Sacramento.Colifor io <br /> UNIFORM HAZARDOUS atei s US EPA 10 No. Manifest Dccurm t^No. 7. Page 1 nfonnanon in the h.ded a em <br /> is not required by Federal low. <br /> WASTE MANIFEST �Cia161011611 IgI4.110 1 U 1 0 0 3 i of 1 <br /> 3. Generator's Name and Mailing Address <br /> k <br /> CITY OF TRACY 520 TRACY BLVD. <br /> TRACY, CA 95376 ATTN: PAUL VERMA blD : t <br /> 4. Generator's Phone ( 20J 836-4420 FFF , <br /> p 5. Transporter 1 Company Name 6. US EPA ID Number <br /> O <br /> C? PETROLEUM RECYCLING CORP. 1 9 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> U <br /> U , <br /> G 9 Designated F.dRty Name,and Silt Address. 10. US EPA ID Number <br /> 'PETROh- 'RECYCLING CORP. <br /> W - ... .' 13331YNORTH HIGHWAY 33 ' <br /> a -"PATTERSON` CA: 95363 1 281 1 <br /> V -- 12. Caaainen 1]. Total 14. Unit <br /> Z ;IT--US DOT Description(including Proper.Shippfng-Nam.Hamid Class,aid'ID Number) No. Wt <br /> amity Nol <br /> ` . NQIll C &4AX-94Poos W'qS j <br /> NE : 1.9 lllD / 61 C)'- <br /> co <br /> m N - <br /> : E <br /> .RJ: _ . .._... <br /> o A <br /> m .T. <:.. <br /> W ., <br /> U _. <br /> W <br /> Z <br /> r <br /> z <br /> Z <br /> 0 15. Special Handling I rrucnons;and Adddiapal Informanan Wj <br /> - /ff l, y <br /> a 24 HR:?sEISITE 9MJ MCY'CONTACT: 1-800-874-4444 t} SY : <br /> Z 24'.HX -,EKERGENCY RESPONSE: CHEM TEL INC. 1--800-255-3924 T�cy� �H <br /> APPROPRIATE PROTECTIVE CLOTHING S RESPIRATOR <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that,the coment,of the consignment are fully and accurately described above by proper shipping nems and are classified. <br /> U �-packed,marked,and labeled,and are in all nspeca in proper condition for transport by highway according to applicable federal,state and insemational laws. <br /> If I am a large quantity generator, I cerfify that I have a program in plxe to reduce the volume and tozaily,of waste generated to the degree I have determined to be <br /> Sesonemically practicable and thel I have selected the practicable method of treatment, storage,or disposal currently available to me which minimizes the present and future <br /> y1 threat to human heahh and the environment,OR, if I can a ...If quantity generator, I have made a goad(aids effort to minimize my waste generation and select the best <br /> a, waste morogem.t method that is available to me and that I can afford. <br /> 0 - I!,, -y.�,��Typed Nam <br /> --•— Month Day <br /> IH�rnaS %/V A.l�'\ r.c.''a.nc�: \.1. i ,.. CJ O of <br /> Z R 17. TromporthAr 1 Acknowledgement of Receipt of Materiah <br /> AP41T9F7Fyhsz1 Name SigMemh Day r <br /> W /7J -e.L �11 Sax / d / 1 743 <br /> 0 18 iter 2 Acknewltd morst of Resin t of Material, <br /> W i Irintd Typed Name '- \ ) Month Day year <br /> W <br /> o ; T.J. <br /> W 19. Discrepancy Indication Space <br /> N <br /> F <br /> U A , <br /> Z C <br /> — 1 <br /> k <br /> l 20. Fen' Owner er r Grfifkation of t of hazardous maseriols cowed b this manifest u< r es rented in Item 19. <br /> T Prinsed/Typed Nam Signeture month Day year <br /> I <br /> DO NOT WRITE BELOW THIS UNE. <br /> Blue: GENFgATOR SENDS Tw15 COPS' TO DTSC WITHIN 30DAYS. <br /> DTSC $=A f7/92) (n P O. 8n. 400, 5nrran,—". CA 919174DAOG <br /> 1t,1 AIM-22 <br />