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.rareor ProtsehanAgenry <br /> Form Approved OMB No.2050-0039(Expires 93694) See Instructions On bock of "' age 6. Department of Ta.k Subaonco Cartrol <br /> Phe er Prim or type. Form designed for one on eine(12,a d carder. Soenowemo,Cdifo.eo <br /> UNIFORM HAZARDOUS 1. ' velar's US EPA ID No. Manifest DocumeN No. 2. Page 1 Information i the,shaded areas <br /> /r O of brat required by Federal Ica. <br /> WASTE MANIFEST 4(/C <br /> 3. Generator's Name and Mailing Address A, <br /> 500 Dowment tk, 93195459 i <br /> an 57— <br /> n l L� SI�i DO <br /> n l <br /> . State Fierarotor's ID _ <br /> smpry 4. Generotoi s Phone ) -L <br /> .7 Ap <br /> ess 5. Tronsporler 1 Company Name US EPA ID Number C. Seats Tro sporize,1D O <br /> so <br /> PRC PATTERSON,INC CAT 10 1810101111101519 ' Laropo sets one <br /> '800-874— <br /> 4444 <br /> Q7. Transporter 2 Company Nome S. US EPA ID Noenber .S tale Troappreer's ID 71 <br /> O� V <br /> ..Trmsporser s Phone. - <br /> d' Z 9. Designated Facility Nome and Site Address 10. US EPA ID Number 4G. Seale FadW,ID <br /> LI) PRC PATTERSON INC I C1 Al11101613111616171218 <br /> !S: 13331 N. HWY 33 H. FavihWs Phone <br /> a la PATTERSON, CA 95363-9998 CAD 0 8 3 1 6 6 7 2 8 :800-874-4444 <br /> M VCn <br /> 12. Comainenea. 13. Total U. 1Ine <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No, T 13. 14./U /. Ware Number <br /> H °' Stoic <br /> 3 223 <br /> G EPA/Odw <br /> b E NON RCRA HAZARDOUS WASTE LIQUID 010111 T10106 <br /> mN b. State <br /> to E <br /> R EPA/Other <br /> A <br /> T c. Sege <br /> O 11 R PA/Other �1 <br /> Y d. Sate <br /> W <br /> V <br /> EPA/Oder <br /> W <br /> fA <br /> OJ. Additional Descrptions for Moleriah listed Above K. Handling Codes for Warm Listed Above <br /> w WATER & OIL )\iN3C G 01 b <br /> W <br /> flS L v w+4fi'Ef[ <br /> � c. d. <br /> Z <br /> O 15. Special Handling lastructions and Additional Inlormahon <br /> 24 HR. EMERGENCY CONTACT: PRC #1—(800)-874-4444 <br /> Z 24 HR. EMERGENCY RESPONSE: CHEM TEL INC. B1—(800)-255-3924 <br /> APPROPRIATE PROTECTIVE CLOTHING 6 RESPIRATOR. <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare shot the contemn al the consignment ore fully and mcurotely deuribed above by proper shipping name and are classified, <br /> ked,marked,and labeled,and are in all m proper condition for hon n b highway aecordi to applicable federal,shite and vaernonerwl laws. <br /> < pa respells P Wr sPa Y 9 v'aY ^9 <br /> V <br /> R 1 am a large quomisy generator,1 certify Mot 1 have o program in place to redoce the volume and toxicity of waste generated to the degree I have determined b be <br /> warvainiculty practicable and that I how selected the practicable method of treatment,storage,or diWa.1 currently available to me which minimizes the present and"n. <br /> Nthreot to human beohh and the mviromment;OR, R 1 oar a small quantity generotor,I hove made a good faith effort so minimize my waste generanan and select the best <br /> woste mona,grement method that is available to me and Mot I can afford. <br /> O Primed ped No SipnoNro Month Do e <br /> ZT 17. Tran oder 1 Ackwveled arrear of Recti of Moterioh <br /> 0 M Printed/T e` Signature, Mo� Day <br /> W f <br /> F O 16. Tarns rte,2 Ac no d einem of Recti t of Moteriah <br /> W j Prneed/Typed Nome SigraNr ' ino,.h Day Yeo' <br /> tVVV� t <br /> ■ <br /> 1Y 19. Discrepancy Indication Space <br /> < F <br /> V A <br /> Z C <br /> 1 <br /> L <br /> 1 20. lizzeility Owner or Czerwar Certification of rete' t of hazordws materials covered by this manifed exasp,sa need in been 19. <br /> T Primed/Typed Name SigmduH, Month Doy Year <br /> Y <br /> DO NOT WRITE BELOW THIS UNE. <br /> White: TSDF SENDS THIS CONY TO DTS: WITHIN 30 DAYS <br /> DISC B022A (7/92) To: P.O. Box 3000, Socromemo, CA 95E12 <br /> EPA 8706-27 ' <br />