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State of Colilornlo—Ehvirolimer+cil Rrolection Agency <br /> ' See Instructions on back of nage 6. Department of Toxic Substances Conlrol <br /> Form Approved OM6,No.1050 0039(Expirfi 9-30.94)i Please print or type.:,' a'r'm designed fol'via on elite(12pitcl ,ire,. Sacramento,California'� <br /> generator's US EPA ID No. Manifest Documem 2. Page 1 Information in the shaded areas <br /> UNIFORM HAfARDOUS is not required by Federal law. , <br /> WASTE MANIFEST CI Al TI 41 of <br /> 3. Generator's Name and Mailing Address <br /> i. 10 EF <br /> TQSCO RUINING CO.to <br /> r <br />! ^ 3505 NAVY DR. , STOCKTONo 'CA. ' 95203"1001' ''' <br /> I N 4. Generator's Phone ( 466 <br /> _00 <br /> Y ) <br /> 5. Transporter 1 Company Name 6. US EPA ID Number bt <br /> Gt <br /> oi:Ys <br /> t �otir. <br /> 7. Transporter 2 Company Name 8. US EPA ID Number !E .Skil <br /> m Q 9. Designated Facility Name and Site Address i.US EPA ID Number C`i <br /> PRC PATTERSON, INC. <br /> �0 13331 N. ciwiC. 33 <br /> LL I' r� r <br /> ~a <br /> PATTERSON, CA, 95363 1 CI Al DI 018131 11 Al 1;1 71 1 <br /> Q V 12. Container 13. Total 14. Unit t�'0 <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> (�Z No. T QuantityWt/vol `er : <br />! M a. <br /> ~ OIL, WATER NON RCRA HAZARDOUS WASTE LIQUID <br /> c� E lit <br /> cco) N b. si ; <br /> E Petroleum Recycling Corporation certilles if )ic ntion ,ri <br /> CN R vvaste(s), morespecifically identified <br /> 0 T t• set forth above, Was were recycled r, -�cc rdan e <br /> the provisions of 40CFR261.6 and 23. 1 c 1 = i t0 FR _6 <br /> v •, <br /> W R ') waste -frerr� t v11 Its t�.. o f <br /> Z d• rovision <br /> recycled in accordance with the <br /> p i% CFR 66 Su pa t ). <br /> LU PETRO FUM RECY 'LI u I ' a <br /> Z I /1 d'1to"bl fi 'r� hibl�e�rtalf isld �kr r=` t. i, tsss�+e4R 7s " 1. W ,sl,fi, <br /> 1 <br /> 1 4 t <br /> — .0•• •0 ,,�. ''�" s � .\ 1�l r '�+ rI .{'2 is x •, �,. <br /> , <br /> Z 15. Special Handling Instructions and Additional Information <br /> O <br /> P <br /> 24 HR EMERGENCY CONTACT: PRC PATTERSON (800) 874-4444 <br /> 24 HR EMERGENCY RESPONSE: CHEM TEL, INC. . (800) 255-3924 <br /> w WEAR APPROPRIATE PROTECTIVE CLOTHING AND RESPIRATOR <br /> X <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 /> Qpacked,marked,and labeled,and are in all respeds,in proper condition for transport by highway according to applicable international and notional government regulations. <br /> U <br /> J 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 /> 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 /> n- 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 /> N waste mann ement method that is available to me and that I can afford. <br /> Printed/Typed Name Signature Month Day Year <br /> U I 17. krVsporter 1 Acknowledgement of Recet t of Materials <br /> Z R <br /> t w A Fri ted y d Name l / Si r� 1Month� ry Da ear <br /> LU Vlo� <br /> 0 181 Transporter 2 Acknowled ement alll Recei f of Materials <br /> Month Day Year <br /> t11 T Printed/Typed Name ignature <br /> LL E Q R <br /> LU 19. Discrepancy Indication Space <br /> N <br /> Q F --- <br /> U A <br /> C <br /> r Z I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name `- ^l Signature Month 7Day Year <br /> 7'� <br /> " J DO NO,"kITE BE W THIS LINE.- I <br /> �� Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DISC 8022A (9/93) (Generators who submit hazardous waste for ttansport oul-of-state, <br /> EPA 8704-22 produce completed copy of this copy and send to DTSC within 30 days.) <br /> •N <br />