|
s:v of California--Environmental Protection Agency _ k
<br /> rm Approved CM8 No.2050-0039(Expires 9.30.94) St3£ Irl St�tJ i:t10I'15 on back of page 6. Department of Toxic Substances Controi F4
<br /> p " f Sacramento,California
<br /> ,ase print or type. Farm designed For ase on elite(12-pitch)
<br /> ypev' P
<br /> G or.US EPA 10 No: Manifest Document No. '1. Page 1 Information in the shaded areas
<br /> not required by Federal law.
<br /> UNIFORM HAZARDOUS 1
<br /> WASTE MANIFEST CI A C 0101 01 9171 01 41 11 0 01 01 01 01 1 of 1
<br /> } A State Manifest Docurnant Num { '
<br /> 3, Generator's Name and Moiling Address - r
<br /> CITY OF TRACY 520 TRACY BLVD.
<br /> r
<br /> TRACY, CA 95376 ATTN: PAUL VERMA ri s Generator D er r y
<br /> A. Generator's Phone (2 d 9) 836-4420 -- `^. •"�` .i+�-^" S _''
<br /> 1 3. Transporter E Company Name 6. US EPA ID Number C StoM'TrdnspoRer sID � sZv
<br /> Xr
<br /> Q '
<br /> PETROLEUZ4 RECYCLING CORP. C T 0 0 1011 j 059 D Transpartcrs,Pharsex, $�jQ=$7[p+-1►C1d�
<br /> 1 -r'.rss�'r
<br /> 8. US EPA.ID Number E sSlate Transporters Id" ?� ' r+r>�
<br /> 7. Transporter 2 Company Name fc
<br /> ... '� r' x+r -a+. M MW
<br /> I I I 1 F Tr �. rlrrrs,Phane �.,.' sa��+•r<�'r'�r��� +!T
<br /> anspo a. - x :a< ]..'}n,�,..wry, r ,�'•..� `'
<br /> 9. Designated facility Name and Site Address 10. US EPA ID Number G State FaGftty-s�D 3 vn rf
<br /> CYCLI�GG CO- -0011 ,s .*PETRDLEUM RP
<br /> 13331 NORTH iItiHAl n Y ,
<br /> 33 H FCGlify s. W2154',�.
<br /> PATTERSON, CA. 95363 I 1 W 83 166 728 I �
<br /> 12. Container 13, Total I 1.5. Unit
<br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number
<br /> No. Toe Ouontfty WtJVaI f 1Nriste
<br /> a. State c Ci
<br /> NON RCRA HAZARDOUS WASTE LIQUID
<br /> I - 23
<br /> (WATER, OIL} 01 01 1 T I T �I�I I ISI G :, ;'Iy
<br /> ' R
<br /> sfa>a1,r ,fa
<br /> R EPA/Otwiwryy�s3?� •Ft
<br /> ;701 :r_
<br /> ' 4 dig�.g
<br /> -State �f£--
<br /> d. =< s�i.:t
<br /> Y .-
<br /> I 'EPA
<br /> t Addisliorsaf Dgscrrplrons forts emIs Cuted Above i •� - y-rye is r - K Handling Codes fu Wasies Lsted Above
<br /> s s i� .tw... �•'� ��,�,nM' '�r'7'�r"Ss ,p � rn ,y��
<br /> :.N r✓, iri w{ _. "t` 'ti�'•t•��y+"11r T - 'nom Try -4,w i '?•3..-
<br /> [/�,� ;
<br /> 15. Special Handling Instructions and Additional Information '
<br /> SITE: 10 W. GR AUNT LINE :�.
<br /> 24 HR. EMERGENCY CONTACT: 1-800--874-4444 TRACY, CA
<br /> 24 HR. E21ERGENCY RESPONSE: CMTEL INC. 1-800-255-3924
<br /> I
<br /> APPROPRIATE PROTECTIVE CLOTHING & RESPIRATOR
<br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified,
<br /> packed,marked,and labeled.and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws.
<br /> 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 /> i
<br /> economically practicable and that I have selected the.practicable method of treatment,storage,or disposal curremly available to me which minimizes the present and future
<br /> threat to human hearth and the environment; OR, if 1 am a small quantity generator-l.have made a good foitfs effort to minimize my waste generation and select the best
<br /> Iwaste mono ement method that is available to me and that I can afford.
<br /> Printed/Typed oma ✓"� Signaturesr '% Month Day ear
<br /> /-� �-,7:�'�1 / ;� ��'- ./� _ -�✓_�..,, �-�� / , CSI �.� I I �3
<br /> T 17, Transoarter 1 Acknawied ement of Receipt of Materials
<br /> i 4
<br /> 7 rent Name
<br /> L 0 5 , r a s
<br /> � N
<br /> I '
<br /> ❑ Trarssaorter 2 A<knowled emer+t of iteceiot of Moteriah
<br /> I st t
<br /> Signature
<br /> oDay Year
<br /> Printed/Typed Name Month
<br /> ' E I I
<br /> R
<br /> 19. Discrepancy tndication Space ,
<br /> F
<br /> I A
<br /> C
<br /> LI
<br /> I 20. Facility Owner or Operator Certification of yttriat of hazardous materials covered by this manifest excrot as noted in item 19.
<br /> T ^•inted/TYPed Nome ' Signature I Month Day Year
<br /> } Y I I 1
<br /> DO NOT WRITE BELOW THIS UNE:
<br /> Blue: GENEgATCR FENDS THIS CCPY TO DTSC WITHIN 30 DAYS,
<br /> SC 8022A (7/92) To: a.C. =cx A00. Sacramenro, CA 958t2-Ca00
<br /> 8700-22
<br /> r
<br />
|