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Ssste of Cahlormo--End.enmemal 0.erecrnn Ager¢y See Instructions onoof page 6. No .al Fa.c sabutim <br /> Approved Apprad OMB No 2050.-00]91E.pi.es 9-30- _.,k <br /> 5ovmnenra.C.14" <br /> Peace Paint e.rya. Farm designed lo...on alite 119mh) ypawraer. <br /> 1. Generator's US EPA 10 No. Manifest Daument No. j 2. page 1 I Information in the shaded ser. <br /> UNIFORM HAZARDOUS is nor rewired by Federal Ip- <br /> WASTE MANIFEST C AI D 9 8 1 3 7 7 8 7 2 0 2 9 8 9 1 of 1 <br /> 3. Gmeml.r s Name and Mailing Address A Sf°t°Nf°nsF°C D°arwr�' - M `se I <br /> o LAIDLAW CORP. 1 <br /> r <br /> 1444 TILLIE LEWIS LANE, STOCKTON, CA. 95206 ,I " <br /> Cr A. Onme ,mrsPhane (209) 838-3507 , <br /> us, <br /> 6 5. Trpmprt <br /> oer 1 Company Name 6. US EPA ID Number sptepash/s _ 11 Q../W. S.+ <br /> O <br /> m w1amtsy6itesPh.':; OG.4- 444 <br /> PETROLEUM RECYCLING CORP. T 1040 0 1 1019 ='-4*- . _ � <br /> 7. Transporter 2 Company Name 8. US EPA ID Number > i ik i <br /> U <br /> a—A Z 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> PETROLEUM RECYCLING CORP. w.e <br /> 13331 NORTH HIGHWAY 33 if lta . <br /> a--I a tmiss <br /> Crj U 12. Contains. 13. Total 14. Una <br /> Z 11. US DOT Description(including Proper Shipping Name.Hazard Class,and ID Number) 7 Quantity Wt/Vol Pt. `h:Tifn16er <br /> - <br /> 3 NON RCRA HAZARDOUS WASTE, LIQUID 223 <br /> E (PETROLEUM HYDROCARBONS D1011 / G <br /> m N b. q <br /> m E <br /> T <br /> co <br /> O ': > <br /> ac R I FPA/Other <br /> W <br /> .State :. <br /> W <br /> N <br /> Z Codes fel�.'.Vl,4WrfsdAEow �. <br /> i. <br /> O <br /> a <br /> 0 15. Special Handling Instructions and Additional Information <br /> F= <br /> z 24 HR. EMERGENCY CONTACT: 1-800-874-4444 <br /> 24 HR. EMERGENCY RESPONSE: CHEFS TEL INC. 1-800-255-3924 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment an fully and accurately described above by proper shippig name and are dasuht <br /> Qpacked,marked,and labeled,and are is all respects in proper candi man lar vpnspon by highway according to applicable federal, ,we and international laws. <br /> V <br /> If I am a large quantity generator. I comfy shot I have o program in place to reduce the volume and toxicity of waste generated to the degree 1 ha.e determined no <br /> J economically practicable and Mat-I home selected the practicable method of srm suit,storage,or disposal currently available to me which minimizes the present and Iv, <br /> threat ra human health and the envs.1;OR, a I am a smell quantity generator, I have made o good Isiah effort to minimize my waste generation and select Me h <br /> cc waste management method that it available to me and that I can afford. 17 <br /> O Printo/Typed Name Sig a Marsh Day <br /> Y - Ll -. ." 1 <br /> m <br /> Z , 17. Transporter 1 Acknowled a eat of Receives at Materials si <br /> W Primed/Typed Name gmNre .Moms, Dov <br /> s. <br /> 0 18. Trans per 2 Acknowledgement of Receipt of Materiah <br /> W r Printed/Typed Name Siongt6r. Moms, Day <br /> w f I <br /> O I <br /> W 19. Discrepanc,Indication Space <br /> N <br /> Q F <br /> V A <br /> Z_ c <br /> 20. Facility Owner or Operator Cerefication of recei t of hazardous mateials covered b this manifest eece r as noted in Nem 19 <br /> T Printed/Typed Name Signature Moms, Opy <br /> y <br /> DO NOT WRITE BELOW THIS LINE. <br /> r OTSC 8022A (71921 <br /> EPA 8700-22 <br />