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Dcp°rtmeni of Toxic Subslanccs.COW10'1 <br /> ®en y See Instructions on back of pa9 a Socromenlo,Cal""'C <br /> o{Cali4°rnio�nvironmer4al Protea+inn A c <br /> gpprovcd DMB NO,2050--0039(Expires 9-30-94) 0 Information in the shaded areas <br /> s,-print or type. Form desi,,-d for use on elite(i2-pltchj rypewr —Manifest Dxument No, 2. Page 1 <br /> 1. Generator"s US EPA iD No. is not required by Federal law. <br /> UNIFORM HAZARDOUS ! 2 of 1 <br /> WASTE MANIFEST CAD 9 8 21 0 0 2 4 1 2 0 4 31 3 <br /> Generator's Name and Mailing Address <br /> SAN JOAQUIN DELTA COLLEGE sly Cenerator s ID <br /> CA. 95207 <br /> 5151 PACIFIC AVE. , STOCKTON, � <br /> (209) 47405035 �( <br /> 4. Generator's Phone 7 p �`l3- <br /> 6. US EPA 1D Number �/ <br /> 5. Transporter 1 Company Name pyr., - <br /> A T 0 8 0 1 1 0 5 9 D. TT tiS`J G"8i 6 7 <br /> PETROLEUM RECYCLING CORP- S. 1 5 EPA 10 Number E. state Transporterrs ID <br /> 7, Transporter 2 Company Name `'` ' '„t•'%"'' <br /> r�u >s <br /> J <br /> esiSlid <br /> 10. US EPA ID Number _' i s - <br /> 9. Designated Facility Name and Site Address #F t <br /> PETROLEUM RECYCLING CORP- <br /> 13331 <br /> ORP. sr <br /> � H}Fbctis Ph«re a�,� <br /> _ 13331 N. HIGHWAY 33 2 8 1 � p � " 8927 61,�+K2 .� <br /> PATTERSON, CA. 95363 Q A Q $ 12. Containers 13. Total 14. Unit <br /> T dant' WJt/Vol � <br /> 11. US DOT Description(includingNo.Proper Shipping Name,Hazard Class,and ID Number) <br /> _ <br /> �= OIL, WATER i3Oty' RCRA Y,AZARDouS WASTE LIQUID 0` 0 1 T O Q q G <br /> E 7 st <br /> 0o N b. EPA/ t 1 <br /> C <br /> I <br /> R Sf ea*��`agx <br /> A <br /> T ` E.PA/Ler h <br /> R I Statr <br /> d• — <br /> E?r/Criher <br /> y < <br /> r ,s cr• r 'ter K. Handling Codes fOr-Wastes Listed Abavc <br /> LO -00 <br /> O 15. Special Handling Instructions and Additional Information <br /> ~ 24 HOUR EMERGENCY CONTACT: PRC/ENVIROPUR (800) 874-4444 <br /> 24 HOUR EMERGENCY RESPONSE: CHEM TEL INC. <br /> (800) 25S-3924 <br /> 'I WEAR APPROPRIATE PROTECTIVE CLOTHING <br /> �I <br /> lb. GENERATOR'S CERTIFIG4TION: I hereby declare that the contents of the consigpment�re fullyyand accurately described le federal,state andy proper s international Iawsing name d are classified, I <br /> J` packed,marked,and labeled,and are in all respects in proper caodition for transport <br /> b hlghwa oc:ordin to app i <br /> 11 _-� { <br /> If I am o Sorge quantity generator, I ceniiy that I hove a prograr. :n place to a :jr-tile volume and toxicity of waste generated to the degreizese I have determined to be <br /> economically practicable and that I have selected fire practicable method of treatment,storage,or aisposal currently available mi me which a genera rhe p d set ,, ure <br /> threat to human heakh and the environment;OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste mono eine"'method that is availo6le to me and that I can afford. - Month Day Year <br /> >igna (215 aqlq <br /> Feinted% <br /> waste mono o Na - - <br /> T 17. Trans rter 1 Acknowledgement of Recei t of Materials Month Day Year <br /> Signature (7 I L <br /> r. Printed/Typed Name ,/p t fx <br /> s 0 K , Vel <br /> rr Month Day Yeoi <br /> 0 18. Transriorter 2 Acknowled ement of Recei t of Materials Sogna e i <br /> W R Printed/Fyped Name ` <br /> T <br /> E <br /> R <br /> 19. Discrepancy Indication Space <br /> � F <br /> A <br /> C <br /> I <br /> L Month Day Year <br /> 20 Facil' Owner or orator Certification al recd t of hoxordous materials covered b this manifest exce t as nosed in Item 1 <br /> Printed/Typed Name <br /> DO NOT WRIT BEL( Jr THIS LINE. <br /> �� 'While: TSDF SENDS THIS COPY TO D15C WITHIN 30 D %,, <br /> To. P-O. E.ax 3000, Sacramento. CA 95812 <br /> 'DTSC BD22A {7/921 <br /> EPA 8700-22 <br />