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State of California--Environmental Protection Agency <br /> Form ApprovedAMB-Ne.2050--0039(Expires 9.3494} See.Enstfuetions on bock i!ie 6. Deparlmam of Toxic Subsm.Cannre <br /> Please-print or type. Farm designed far use an etre(l2pisdr}typewriter. - Sacramento,California <br /> e 1. Generatofs US EPI ID No. Manifest Document No. 2. Page I Information in the shaded areas f <br /> UNIFORM HAZARDOUS � � � � is not required by Federal law. <br /> WASTE MANIFEST of <br /> 3. Generator's Name and Mailing Address <br /> 4.:Generator's Phone 157-9731 > 1 oe`Z/z-10 C4 /._QD&: <br /> _-•G 5. Transporter 1 Company Name 6- US EPA 10 Number ' <br /> ao PRC PA'L'TmuN;vt—' ICI.A I T 81 0 10111 1 101519 <br /> J P <br /> US 8 <br /> N <br /> 2 C <br /> t <br /> T <br /> 7. Transporter Company Name . EA ID Number <br /> V a - - <br /> i7 V <br /> 9. Qesirjj Fpu[ipr,);lyp} rd SyWdress 10. US EPA ID Number <br /> ') o 13331 N. HWY' 33 <br />�3 U PATTER50N,CA 95363 CAD 0 8 3 1 6 6 7 2 8i <br /> Z 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> - <br /> Me. T Wt/Vol _ <br /> m 'N 1r;aste ` <br /> b �, df 4 w to ma ifest <br /> N R ort above, Was were recycled in accord <br /> A <br /> FQH I= <br /> o k2�- hazardous waste generated from the recycling effo s was also <br /> R recycled in accordance with the provision of 40CFR266 S b atL <br /> tl " , = OLEUM RECYCLING-CORPORA ION = - <br /> N _ <br /> Z <br /> 0 <br /> V) <br /> W <br /> z <br /> J <br /> Q <br /> Q15. Special Handling Instructions and Additional Information .. _ JUL .J. IZIJ4 <br /> a 24 'HR. FXERGENCY CONTACT:. PRC # 1-(800)-874-4444 <br /> Z 24 HR. EMERGENCY RESPONSE: CHEM TEL INC. 4 .1-(800)-255-3924 ENVIRONMENTAL HEALTH <br /> _ APPROPRIATE'PROTECTIVE CLOTHING AND RESPIRATOR. PERMIT/SERVICES <br /> t- <br /> J 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of.the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q packed,marked,and labeled,and aro in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U <br /> If f am a large quantify generator, I certify that I hove a prcgrom in place to reduce the volume and toxicity of waste generated to the degree I here determined to be <br /> -_economcally.practicable'and that I have selected the practicable method of ireotment,storage'-acdisposal'eurwrtly available to me which minimizes the present.-and future <br /> tn threat to human health and the envirormtmf,OR, 9 1 am o small r I have made a <br /> � quantity generator, ;good Faith e to minimize my waste generation and select the bast <br /> Ce vreste management method that is available to me and that.11 n afford. ) <br /> Q Printed/Ty BtJ4me V� Tt <br /> Sgnahsre <br /> ►�n �..�� . <br /> V <br /> z T 17. Transporter 1 Acknawied ment of Receie of Materials <br /> Printed/T m /`+ - Signaturei'" jAlo <br /> Ws L U <br /> V <br /> 0 18. Trans iter 2 Acknowleclement of Receipt of Materials <br /> 7 Printed/Typed Name' Signature Month Day. Year <br /> U_ e <br /> O R. - . <br /> u 19. Discrepancy Indication Space <br /> ::... :. <br /> V A : . <br /> Z C <br /> L <br /> 1 20. Facility Owner or O erafor Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T7 <br /> Printed/Typed Name ;IVA <br /> Y Signature Month Day Year <br /> . <br /> ri Ver. b '� 4 y <br /> DO NOT WRITE BELOW THIS LINE..-. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. +F <br /> DISC 8022A (7/92) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 produce completed copy of this copy and send to OTSC within 30 days.) <br />