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/UNIFORM <br /> ronmentc=Protection Agency See Instructions on back of p, 6. <br /> .2CSC M39(Expires 9.30.96) Department of Toxic Substances Control <br /> orm Designed foruseonelfin(11Pitciif rypewr,.�r. Socramenro,Califorrda <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> HAZARDOUS is not required by Federal law. <br /> ASTE MANIFEST �CIAJLI 01 01 01 11 51 21 21 21 8 1 01 41 01 5 1 5 of j <br /> Generotor's Name and Mailing Address A- State Marsifes DoR+ment Number- - '7 —p-'^^"^ <br /> J & L MARKET u 57 0 4 4' <br /> S0. EL DORADO ST. , FRENCH CAMP, CA 95231 fs_.State Ceneratars ID <br /> 0, 98_-0897 <br /> /8�115 <br /> eraror's Phone (7p) 7 Transporter I Company Name 6. US EPA ID Number .C.State Tronsporter's ID <br /> D..Tr r <br /> s ENVIROPUR WEST CORPORATION IC IAIT IO I8 1010 11 111015 19 *..�A-4444 . <br /> Q 7. Transporter 2 Company Name S. US EPA ID Number E. State Trcrnporters ID <br /> j r <br /> Transporter',Phone <br /> C <br /> Z 9. Designated Focility Name and Site Address 10. US EPA IO Number G.State Fod{Ay's ID. <br /> PRC PATTERSON, INC. <br /> 1 C A D 018131 j-1 61 6 7-1 218 <br /> O13331 N. HWY 33 H .Facility's Phone <br /> < PATTERSON A. 95363 IClAID10 18131116 6171218 _ 800-874=4444--', w <br /> U 12. Containers 13. TotalI 14. Unit <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. I Type I QuantityWt/Vol t. Waste Number <br /> iF-I a. 1 Slate - - --- :-• <br /> OIL, WATER NON RCP-A. HAZARDOUS WASTE LIQUID <br /> I tt EPA/Other <br /> NI E 01 01 11� T'61 iGIGl4 G I <br /> aI N ' b. 1 State <br /> E <br /> I I I I R EPA/°th°` <br /> z <br /> o( <br /> A II { j 1 State - 1 <br /> Oj o ' I I I 1 <br /> I <br /> —I R I I I V I I I EPA/C <br /> d. _ <br /> Lu _ <br /> U <br /> tLU <br /> r1 1 I I I 1 I EPA/Other <br /> - <br /> 7 J. Ad-'.+tional DesCi ns for Maieriais Uste i Above K. Handlingar <br /> Codes for Wes Listed Above _ -- <br /> O I <br /> d. <br /> 4s. <br /> J I 15. Special Handling Instructions and Additional Information <br /> <� 24 HR. EMERGENCY CONTACT: PRC PATTERSON (800) 874-4444 <br /> 24 HR. EMERGENCY RESPONSE: CHS TEL, INC. (800) 255-3924 <br /> '' I WEAR APPROPRL4TE PROTECTIVE CLOTHING AND RESPIRATOR <br /> �-I <br /> 1 I 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are luny and occvrmeiy described above by proper shipping name and are classified, <br /> UI packed,marked,and labeied,and are in all respects in proper condition for transport by highway according to applicable international and rwtional government reguiations. <br /> — I i If I am a large quantity generator, I certify that 1 have a program in place to reduce the voiume and toxicity of waste genermed to the degree I have determined to be <br /> CI economically practicable and that I have selected the procicable method of treatment, storage,or disposal currenry available to me which minimizes the present and future <br /> v7 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 /> C waste management method t+tat is available to me and that I can afford. .^ <br /> - <br /> O ,I PPrimted/Typed Name G SianatuMonth Day Year <br /> I ICM I d v <br /> 1 I 17. Tronsoorer 1 Acknowledgement of Receiat of Materials <br /> W4 <br /> (� A P ted Ty d Name r Si a Month Day Year <br /> y 0 18. Tra uoorter 2 Acknowiedoement of Receiot of Mmenais <br /> u_ T Printed/Typed Name Signature Manch Day Year <br /> 0, E <br /> N 19. Discrepancy Indication Space <br /> U C / <br /> 1 20. faciiity Owner or Ooer Cersificario of receipt of hazardous material overed by this manif st except as noted in m 19. <br /> T 1 Printed/Typed Name tgnature / Month Day Year 1 <br /> DO NOT>46ITE BEL THIS LINE. <br /> OTSC d022A %1/931 <br /> -?A 3700--22 <br />