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Stole of Caihlaraia—f rissonmernol Protection Agency <br /> lam App orad OMB No 2050-0039(6pLo 9.30.94) See Instructions on back of pa 6. Depnnmenh of lour Substance.Control <br /> Please probit-type. Form de.iprhed for ure an eXrc(12pikM11 0'P %..d Saervhnemo,Coldo.aa <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No 2. Page I Information in the shaded or<os <br /> is not required by Federal law_ <br /> F1 WASTE MANIFEST AL O Z of 1 <br /> 3. Generators Name and Moiling Address _ TS IF N Ib A. State Moral st Dowmeum <br /> Do...Nber <br /> 93195459 <br /> 5 7 6. State Gerroralar's ID <br /> in 4. Generator's Phone 3 Z [� <br /> 00 —/� J <br /> W <br /> p S. Tronsponer 1 Company.Name US EPA ID Number C. State Tmmponer's ID h <br /> V <br /> PRC PATTERSON F INC CAT 0 8 0 0 1 1 0 5 9 D. Trompo nth Phone 800-874- <br /> 4444 <br /> 7. Trans oder 2 Company Name <br /> nQ P P y 8. US EPA Ib Number E. State Tronspormr's ID <br /> U <br /> 'i. Lompode+i Phone <br /> Q <br /> � 9. Designated Fo<ility Name and 5ile Address 10. US EPA ID Number G. Stole Facihry's ID <br /> CJW PRC PATTERSON INCCAD 0 813111 <br /> 6 6 7 <br /> n 13331 N. HWY 3 H. Facility's Phone <br />—I Q PATTERSON, CA 95363-9998 CAD 0 8 3 1 6 6 7 2 8 ' 800-874-4444 <br /> U sa12. Comm.." 13. Total 14. Unit <br /> Z 11. US DOT DOipGon(including Proper Shipping Noma,Hazard Class,and ID Number) No. T Quantity Wt/Vol 1. Waste Number <br /> State <br /> 3 223 <br /> O 0 EPA/Other <br /> G <br /> o <br /> I <br /> NON RCRA HAZARDOUS WASTE LIQUID 0101 I TIT <br /> ca N Is State <br /> E <br /> � R EPA/giber I <br /> d A <br /> T Stour <br /> m C <br /> � R EPA/Other <br /> w <br /> Z I d. Stora - <br /> W i <br /> U <br /> W EPA/Other i <br /> N <br /> J. Additional Deuriptons for Materials Listed Above ((�� N. Handling Codes for Wastes Listed Above <br /> W <br /> art WATER 6 OIL k 1 A)-%C A-1-e- 01 b. <br /> C <br /> DSL v w 'qJtic d. <br /> Z <br /> z <br /> 0 15, Special Handling Instructions and Additional Information <br /> 24 HR. EMERGENCY CONTACT: PRC il1—(800)-874-4444 <br /> Z 24 HR. EMERGENCY RESPONSE: CHEM TEL INC. I/1—(800)-255-3924 <br /> APPROPRIATE PROTECTIVE CLOTHING 6 RESPIRATOR. <br /> 16 GENERATOR'S CERTIFICATION: I hereby declare that the common of the consignment are fully and acaummly deudbrd above by prop..shipping nom,and are dmdlsed <br /> Qended,mated,and labeled,and are in all re,,neo,in phop.,condition for,..,port by highway according to appbmbic Iedeml.dam and inmrnathonnl laws <br /> V <br /> If I am a large quantity generator, 1«dify Mot I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be <br /> J economically practicable and that 1 have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> � <br /> N threat to human heath and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generar.on and select the best <br /> rc waste management method that is available to m<and that 1 can afford. <br /> 0 Printed ped No Signature /F Month Da <br /> U <br /> Z s 17. Tampa 1 Acknowled einem of Recei t of Materials ' <br /> w <br /> 0. A Printed/Ty o�T Signature Month Day ,YF <br /> W s2.0 <br /> r <br /> O 18, Turns oder 7 Acf.now ed enhent of Recei f of Maledals <br /> W <br /> LL t Printed/Typed Name Signature Monts Day Year <br /> ' <br /> 0 <br /> W 19. Discrepancy Indication Space <br /> N <br /> F <br /> V A <br /> Z C <br /> 20. Facility Owner or O Orator Certification of r.ei t of hazardous materials covered by this manifest except as noted in Item 19. <br /> Primed/Typed Nome Sigmoture Month Doy Year <br /> DO NOT WRITE -BELOW THIS UNE. <br /> White: TSDf SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DISC 01 (7/92) To: P.O. Bos 3000, Socramento, CA 95812 <br /> EPA 117110-22 <br />