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Arne of California—Emeironmeeml protection Agency farm Approved OMB No.2050-0039(Expims 9-3094) `411000, See Instructions on back of pagrwill. Detrainment of Toxic Subaances Control Phone Prot or type. Form designed for use on elite(12pRch)ypewrmr. Sacramento,California UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest D... t No 2. Page 1 nformation in the shaded areas �� D f Z- / I is not required by Federal law. - WASTE MANIFEST ll/� � of J. Generoror's Name and Mailing Address /r/ L O ��C�� -{s'Stole M+e fess Do�u eN N be691 'a,, O sirs a o u'l � ' ' ^ n Z NvA`t� ✓� �r( ' B State Gerwrato{s-ID - r t fR ~ a .. Ge era o;,Phone U J 3 731 5 e ie C'.4 3 5. Transporter 1 Company Name 6. US EPA ID Number C Sea+ T,-n! ... O 1 Ot.'_ _. D.T nspadr,sPfare _ ' PFTRnTF1Jy RECYCLING CORP. LA 7C 10 18 10 10 11 1 9 3 4-4444 7. Transporter 2 Company Name S. US EPA ID Number E. State T ....raters ID' U F. Transporfer's Phone Q 9. Designated Facility Name and Site Address 10. US EPA 10 Number G. State Fadity's ID - 0 PRC PATTERSON, INC. CIA ID.10 18 13 11 1E 16 i7 12 18 _ LL 13331 N. EIY. 33 Hi Farerty',Phone- PATTERSON CA. 95363 C IA P 10 18 13 11 16 16 17 12 18 - 800`874-4444'• - 1I. US DOT Description including Proper Shipping Name,Hazard Class,and ID Number 12. Containers 13. Total 14. Unit Z P (i 9 iK PPS^9 ) No. Type Ord Wt/Vol I. Wane Number-. o. ', Sfate 3 223 G I EPA/Other- o E G 5. E , raste(s), more specifically identified by reference to the win to ma life t n set forth above, Was were recycled in accorda9cy win PA,O eat oT N• :+/:.siG i. State D (2) haza,dous waste generated from the recycling effor s was also ' w R recycled in accordance with the provision of 40CFR266 Sybpart P. W d. PETROLEUM RECYCLING CO ORA ION S" U EPA/0n,, Api, IIII ^� J. Addnronal Deunpfions for Matenah list A I n PSS dimes Codes for Wastes lined Aba, p k YID ` "WATER & OIL 01 � Z I `"'` Y S�Zi 15. Special Hono,,u insrr^cnon:and Addlfiond Imorrnenon N a 24 P.R. EMERGENCY CONTACT: PRC G1-(800)-874-4444 2 5 1994 W 24 HR. EMERGENCY RESPONSE: CMI TEL INC. #1—(800)-255-3924 JUL APPROPRIATE PROTECTIVE CLOTHING @ RESPIRATOR. 16. GENERATOR'S CERTIFICATION: I hereby declare that the confers of the consignment am fully and accurately described above by proper shic U packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,store and infemoti l i If ram a large ant generator, I cer that I horn a program place to reduce the volume and toxicity of waste J g qu rle gnd t fy p bl m p« N generated to the degree I have determined future re K economically practicable and that 1 have netted Me practicable method of treatment,storage,or disposal currently available to me which minimizes the present and Future y threat to human health and the environment; OR,if I am a small quantify generator, I have made a good faith effort to minimize my waste generation and select the best id waste management method that is available to me and that I can afford. O Priced/Typed /n�qfx� Signature U V , 1n Morh a �� A U Z * 77. Transporter I Acknowled ement of Receipt of Materials W c Vat N Pr yped are S'' naNrc — �2 /��,s 9 Moth cc W z s .�t , Yvs ^ W , F o 18. Transports,2 Acknowledgement,of Receipt of Materials LLi Prired/Typed Nome SigraNre Month Day Year O E Y Its 19. Discmpancy Indication Span N Q F U p Z C I L I ?0. Facil' O«ner or Operator Certification of mcei t of hazardous materials covered by this manifest except as noted in Item 19. T Printed/Typed Name Signature Monts Day Year Y �5t�� ever 'tS CQ--�� 6 ) h C� 1I DO NOT WRITE BELOW THIS LINE. - Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. s +y� OTSC 8022A (7/92) (Generators who submit hazardous waste for transport out-of-state, %PA 8700-22 produce completed coon of this cane and send tc DTSC within 30 days.i