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State of Colifo, io--Environmental Protection Agency <br /> Form A,,p,o-c!CMB No.2050-0039(Expires 930.96) See Instructions on back 'age 6. Department of Toxic Substances Control <br /> Please print or type. Form designed far use on e/ile(12-pitc 'liter. Sacramento,California <br /> UNIFORM HAZARDOUS Generator's US EPA ID No. Manifest Document Ivo. 2. Page 1 Information in the shaded areas is not required by Federal law. <br /> WASTE MANIFEST C A ���00 7 3 7 7 0 2 5-- 2 0 of 1 <br /> 3. Generator's Name and Mailing Address A. State Mnnifest Document Number <br /> 95802520 <br /> � r�H O L.,. L <br /> ,DON RODGERS J�J r <br /> 11900 S. UNION ST. , MANTECA, CA 95336 B State General ID R, <br /> d n i <br /> LO A. Generator's Phone209 X65-7�st <br /> co <br /> 15 <br /> 6 5, Transporter 1 Company Name 6. US EPA ID Number CState Trarpporfer <br /> NOP, CAL OIL C AD 9 82 4 17 2 55 _s, <br /> WTrion pxxfSrr! <br /> Q 7. Transporter 2 Company Name 8. US EPA ID Number E;State Tiro s"rter'!Ib q> i.x: 1� 11 t7 1 tyt <br /> U <br /> �. <br /> F.'Trans1I rter's Phone <br /> l\)Z 9. Designated Facility Name and Site Address )0. US EPA ID Number G. State F cility's ID <br /> L n w PPC PATTERSON, INC. 4 <br /> CV 0 13331 NORTH HWY. 33 H. Faci t 's Phone <br /> PATTERSON CA 95363 _ 1 C� OD 0 3 1 6 7 8 <br /> 11. US DOT Description mc!udln Proper Shipping Name, Hazard Class,and ID Number 12. Containers 13. Total 14. Unit r.�.. <br /> if)Z P ( g F FPi^9 ) No. Type Quantity Wt/Vol I. Waste,Number <br /> J7~ NON—RCRA HAZARDOUS WASTE LIQUID state <br /> 3 <br /> G (WATER & SLUDGE) 0 (_ 1 T T G EPA/Other <br /> ci E <br /> CO N b. State <br /> co <br /> .} E <br /> R EPA/Other <br /> o A <br /> o T C. State <br /> te <br /> O <br /> a R �•EPAk <br /> /Oth y� <br /> LU ' Ik Y <br /> Z dUA <br /> . Stt t� <br /> V Vit: <br /> LU EPA/Othk w <br /> V) <br /> OJ. Additional Descriptions for Materials listed Above K. Handling Codes for Wastes Listed Abbva> <br /> CL n. b, $r <br /> Uj TANK BOTTOM WASTE <br /> C. , dW�4 i ' <br /> } <br /> Z <br /> O 15. Special Handling Instructions and Additional Information <br /> H <br /> Z APPROPRIATE PRir1TECTIVE CLOTHING JOB SITE: <br /> W "EMERGENCY CONTACT: (209)667-6692" 515 W. CHARTER WAY <br /> SEE E.R.G. 31 STOCKTON, CA <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> Vpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> r If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> J <br /> n economically practicable and that I have selected the practicable method of treatment, storage,or disposal currently available to me which minimizes the present and future <br /> V1 threat to human health 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 /> fX waste management method that is available to me and that I can afford. <br /> O Pri d/Typed Name Signator lylonfh Day Year <br /> U Q r 6 <br /> to T 17 runs rte' 1 Acknowled eme t of Receipt of erials <br /> () A Printed/Typed Na a Signature antis bay ear <br /> ckt N <br /> W P �AAU 01ericls CC..JJ <br /> W 0 18. Trans rt 2 Acknowled emen:�j <br /> cei t <br /> w I printed/Typed NameSignature Month Day Year <br /> O E <br /> A <br /> V) 19. Discrepancy Indication Space <br /> Q <br /> V FA <br /> Z C <br /> I <br /> I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in nt 9. <br /> T Printed/Typed Name Signature / Month Day Year <br /> Y <br /> r r n <br /> DO NO RITE OLOXITHIS LINE. <br /> White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A (1/95) To: P.O. Box 3000, Sacramento, CA 95812 <br /> EPA 8700-22 <br />