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o^s'a---Er:.+r nwnt I Prelec)wn Agency �/'•�) <br /> App If B No 2050-0039(Expires 9.30.9A) See Instructions on bockbr o e 6. - <br /> �/,]ease pmd- Nw• fe de.,gned ler a,.an-ere(12yihh)t pew.iser. ._ P 9 Dlpert ,e e1 Texi S�b,:en<x,Ce <br /> Sec.—Its CeGfe.me <br /> UNIFORM HAZARDOUS 1• Geroratoh U$EPA ID P}e, Manifest Document No 2. Pepe 1 Infoirnat.in the shaded ones <br /> WASTE MANIFEST C A Cl010111011171811161 (� 7 is rot required by Fedael low, I <br /> 1 6 /of <br /> .3, C»rorotori Name and Mailing Address . . <br /> $.- FEDRALEMERGENCY MANAGEMENT AGE14EY -r <br /> Ln 500'-ST: , S.W. R0014 607 WASHINGTON, DC. 20472 ar ` <br /> A. Geceraturs Phone (202) 646-3061 <br /> O S. Transporter) Company Name 6. U$EPA ID Number <br /> L� AL TED PET ELM <br /> Q - i Trampern"2.Compary -- <br /> .___._.__. ..S. US EPA ID Number-. <br /> LQ Designated Facility Name and Site Addass <br /> o 9.REFINERIES SERVICE 10. US EPA ID Number h f <br /> 13331 14 HWY 33 2 8 <br /> P ERSON CA 95363CAD083166711 <br /> 26 <br /> Z 11. US DOT Description(including Proper Shipping Name,Haxord Class,and 1D Number) 12. CoMeinen 13. Total 14. Unit <br /> F a. <br /> No. T Quantity Wt/vy,vite•fiumbesrl' <br /> NON RCRA HAZARDOUS WASTE LIQUID <br /> 3 G. <br /> N E ' 01 .4 r r-''/ it <br /> N vtn t ( T T G :✓ s"1 � <br /> specificall ) les that the ai�ove +� z <br /> .E s t = ,r,'. t Yidentified b ref •en[io ,ed _ s, a.,<< <br /> L R h. e' was Were roc clerence to the was nes <br /> A .-dl 1 L <br /> 'T 2) rc ;r, t .and 23.4 t <br /> ase generated from the Pursuant t <br /> R o 400 R a61 IO , <br /> eCYcied In accordance with the Ycim c <br /> Z g effort <br /> Z d'` PETROLEUM bAart D. <br /> U <br /> r \ RECYCLING CORP A I N <br /> ��o <br /> L� a> <br /> a x <br /> Z <br /> 0 15. Special Handling Instructions and Additional Information 17LK `� l e •� <br /> USE APPORPRIATE PROTECTIVE GEAR r e / <br /> DESIG14ATED FACILITY EMERGENCY CONTACT # (800) 874-4444 Geyer• Lb �-( irrl, LJ 4,' <br /> = GENERTCR EMERGENCY CONTACT # (202) 646-3061 StuC/l�v� � j <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that Hat contents of the consignments ore fully and acarately described above by proper shipping name and are<I`assifled, <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 /> U <br /> i <br /> •If I am es large quantity generator,I certify that I hove a program in place to reduce the wlume and toxicity of waste generated to the degree'l haJe'detamined.to be <br /> L economicolly practicable and that I how selected the practicable method of treatment,storage,or disposal currently owiloble to me which minimizes the present end fvture I <br /> threat to human heahh and the environment;OR, R I am a small quo" generator, I how mode a good faith effort to minimize my waste genelotion and select the best <br /> r� waste moroffement method that is wagable to me and that I can afford. <br /> 0 Prlmed/Typed Name $iMonth Day Year <br /> me e(;Le C'C4;nr as qn {d gnatvre FEMA T. 14-- oZ fr 0/13 <br /> 7 17. Transporter 1 Acknowledgement of Recei t of Rlateriols / <br /> Ilfrrruuu e <br /> 0 A Printed/Typ a Signature Month Da Year <br /> N ��`N+eqlm�' <br /> w s C--vM eI%. I Y <br /> a 18. Transporter 2:Acknowled emeM'of Recei t of Materiels <br /> a <br /> T. Printed/T No.. Sr:at <br /> gsae .Month Doy year � <br /> a <br /> m 19, Discrepancy Indication Space J <br /> _ F <br /> A <br /> C f <br /> I <br /> L - <br /> I20. FacilityOwner.or rator Certification of recei of hazard.,materials conned b this manifest except as noted in Item 19. <br /> '�. Y Printed/Typed Name Siprwltrre Month Day Year <br /> UDO NOT WRITE BELOW THIS LINE. <br /> DISC 9022A Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> Fox e...,. _(2/92) (Generators who submit hazardous waste for t.ensoon ow clstn:e J <br />