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aim*asLoMrorn�anvlronmenroiProtectionAgency .� <br /> Form Approved OMB No.2050-00$9(Expires 9-3094{ See Instructions on,back of � e 6. <br /> p 9 Department of Tox c Substances Contr <br /> Please prior or type. Form designed for use on aura(f 2-pij' - oewriter. ; +� , Sa<ramento,Coiifomia <br /> "UNIFORM HAZARDOUS `1%�Generator's US EPA ID No. Manifest Docum ,. 2 Pape 1 Information in the shoded areas <br /> WASTE MANIFEST is not required by Federal Tow <br /> `� of <br /> A'. <br /> 3. Generator's Name and Mailing Address <br /> f� ' '"%cft Manifest Dcik iment <br /> TERESI TRUCKING, INC.in I <br /> P. 0. Box 1270, Lodi , CA 95241.1270 <br /> 4. Generator's Phone (209) 3E$-2477 <br /> a S. Transporter 1 Company Name, 6. US EPA ID Number �,;•$bvM TtaruPwterl. ' <br /> bCID „ ,• V92 <br /> NOR CAL OIL CAD 9 8 2 4 17 2, 5 5 a Erna;Phony209j sal <br /> 7. Transporter 2 Company ompany Name <br /> 8. US EPA <br /> a ID Number IE;,Stale Tran, � rfOr's{0`. ' <br /> U <br /> i'i .. <br /> �•'.7 rferti.Phone <br /> Cfia <br /> F r�'�Pa <br /> — 9. Designated Facility Name and it <br /> $ ty Site Address 10. US EPA ID Number O;.$tgf,Tpc$ 'y Ip <br /> Y <br /> ffY <br /> D • <br /> nce PRC PATTERSON, INC. <br /> ': 13331 N.. Hwy 33 , iociP r <br /> n< Pat 4-11:111"Crin IWOY:8744W <br /> 11, US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) `12• Containers 13, Total 14. Unit <br /> 0z No. ' T a Ouantity WI/Vol 1. Wank Pk+mber <br /> �� a' NON-RCRA HAZARDOUS WASTE MUM 223 I; (WATER & OIL) `I'� <br /> 0 b. Skits0'k tl 1 T T D 3 7 5 C E 'r <br /> E <br /> N A EPA/77ttar <br /> 7Y <br /> T c. <br /> °} 0 State <br /> w <br /> oe R a <br /> 4,1 ;P#loftier <br /> F' d. <br /> Z State ' <br /> u <br /> rn <br /> EPA/Other <br /> O J. Add'rHgnaf Desafoticim for Materfoh,listeaf Above <br /> K. Handling Codes for Wastes listed Above <br /> TANK'.BOTTOM MASTE b. <br /> RIRSATE <br /> a - <br /> d. <br /> Z <br /> O 15. Special Handling Instructions and Additional Information <br /> Q APPROPRIATE PROTECTIVE CLOTH1413 .k <br /> Z "EMERGENCY CONTACT: (209) 667-6692'1 <br /> SEE E.R.G. PAGE 31 <br /> 16. GENERATOR'S CERTIFICATION; I hereby declare that the contents of this consignment are fully and accurately desvibed above by proper shipping name and ars classified, <br /> Q packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to a: hcoble international and national government regvlotions. <br /> VIf 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 hove determined to be <br /> economically practicable and that I have selected the practicable method of lraatment, staroge, or disposal currently available to me which minimizes the present and luture <br /> threat to human health and the environment;OR, if I am a small quantity generotar, I have made a good ioitli'effort to minimize my waste generation and selecr the best <br /> un <br /> waste mono errant method that is available to me and that i can afford. <br /> 0 ted ed/ {' �� Of"�f? ageD or signature - '.: <br /> O PrinT(ped Nome <br /> Month Day Year <br /> Teresi Trucking, Inc. ` 1 1 3 0 9 5 <br /> +r i' r/ <br /> * 17. Transporter 1 Acknowledgement of Receipt of Materials ! <br /> LzL a -' !" <br /> UJ A Printed/T ped Name Signature <br /> JU PUETT -�'F !.. Month Day Year <br /> P <br /> o IFI. Trans rter 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Name , <br /> O ` <br /> Signature Morstfs Day Year <br /> I <br /> LU 19. Discrepancy Indication Space <br /> F <br /> U A <br /> ? (- <br /> ! Ck <br /> 20. fa<ili Owner or O erotor Certification of receipt of hazardous materials covere b this manifest ecce !as noted in Item 19. <br /> T Printed/Typed Nome Signalure"1�--- <br /> Y <br /> - 7r r /vPr , 7 / Month Day Yea <br /> /eI � <br /> DO NOT WRITE BELO THIS LINE. <br /> or,C 8022„ (9192) <br /> ------ ---- _-_ Green <br /> - , ll�rffT�rU���K�C�pi�1� <br /> _ --_.-----. - ----------------- - <br /> --- <br /> -------------- NA INS <br />