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•j <br /> T "F1• <br /> 5Yite cf CallfOrnia—Eft"'*,m"tol Protection Agency <br /> Form Approved OMB No 2050.0039(Expires 9349 See Instructions on ` o� page 6- <br /> Pteose print or type. Form designed for use on elite jsrh)typewriter. Deponmrnr at T—,Subsrom- <br /> Sotr^ eeto,Colifo— <br /> UNIFORM HAZARDOUS 1' Generator's US EPA ID No. Manifest Document No. i 2 Page t Information in the shaded are. <br /> WASTE MANIFEST is not required by Federal to, <br /> CAD 9 8 1 3 7 7 8 7 2 0 2 9 8 9 tat 1 <br /> 3_ Generator's Name and Mailing Address A $tate AAcntfest Do[sgnertl s ".L fN. <br /> LAIDLAW CORP. <br /> 1 '7 :1 <br /> r . ' <br /> n 1444 TILLIE LEWIS LANE, STOCKTON, CA. 95206 ? fsf�b"lxtseralofrs"!p. _ �r •.s <br /> 5 <br /> 4. Generator's Phone (209) 838-3507 -"•'� ,.,t, " --s;` '''*.'`- S-k <br /> aD <br /> O 5. Tronsporter 1 Company Nome & US EPA ID Number Trnnsporre�sy,D - -f 0 r _ <br /> -- <br /> PETROLEUM RECYCLING CORP. JC4T 10§0 101110191 1 ibr'ee' `KBO <br /> A, 44444'. <br /> 7. Transporter 2 Company Name 8. US EPA ID Number .P,:.k5tote-Tr,*n$portees'jD <br /> V :'-�•�r. pct•." ., ` �.s,.?+. ,r <br /> 'r� Q 9. Designoted Facility Name and Site Address 10. US EPA ID Number GlafeFuaFityi!I3' x'C <br /> Z <br /> ~ o: PETROLEUM RECYCLING CORP. '� <br /> C 0 �.. <br /> 13331 NORTH HIGHWAY 33 >4-sFa'cWW6PhOMP •-7?-, <br /> -, <br /> Q�yy 11. US DOT Description(includingass,anum <br /> Proper Shipping Name,Hazard Class, ID Number) 12. Comainen 13. To1a1 la » <br /> Unit ' -Z r <br /> I Z No. Type Quantity Wt/Vol :I:�WasteJsimber <br /> Stole.:A:,"' <br /> 3 NON RCRA HAZARDOUS WASTE, LIQUID ' 223 <br /> t 04 E (PETROLEUM HYDROCARBONS) DO <br /> G <br /> coE <br /> c4 R <br /> o A I i-:'— ''- <br /> 0 <br /> co _ <br /> R I EPA/Other <br /> LU I <br /> Sfcft <br /> LU d I <br /> w PI,0,1 <br /> 14 <br /> Z fan' avid Codes for Wosl Listed AbortiLU <br /> 3 <br /> Z <. <br /> O IS. Special handling Instructions and Additiwsal Information <br />' Z 24 HR. EKERGENCY CONTACT: 1-800--874-4444 <br /> = 24 HR. EMERGENCY RESPONSE: CHEM TEL INC. 1-800-255-3924 ' <br /> r <br /> 16. GENERATOR'S CERTIFFCATIONt I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classifies. <br /> Q 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 /> V <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 vroste generated to the degree I have determined to <br /> economically y practicable and that-l'hove selected the practicable method of treatment, storoge,or disposal currently ovailoble to me which minimizes the present and Fuh <br /> threat to human health and the enviromsent; OR, if I am a small quantity generator, I have mode a good faith effort to minimize my waste generation and select the b <br /> waste management method that is available to me and that I can afford. <br /> O Printed/Typed Name Sig a Month Day <br /> } t <br /> V <br /> Z T 17. Transporter 1 Acknowledgement of Receipt ot Materials <br /> W R <br /> U, N Printed/Typed Name gnature ! i .Month Day <br /> LLJ r c E <br /> 0 18- Transporter 2 Acknowledgement of Receipt of Materials <br /> W T Printed/Typed Name Sig , re <br /> -, Month Day <br /> LL <br /> E <br /> Q <br /> R I <br /> N19. Discrepancy Indication Space <br /> Q F <br /> V A <br /> Z C <br /> I <br /> 4 <br /> t 20. Focili Owner or Operator Cerelkation of receipt of hazardous materials covered by this manifest except as noted in item 19 _ <br /> T <br /> Y Printed/Typed Name Signature Month Day <br /> II <br /> S <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8072A (71921 <br /> EPA 8700--22 <br />