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� J i <br /> -,f Colifomlo— „L <br /> EnvironmeAal Protection Agency CEI VEu <br /> -003 + vack l(� <br /> kpproved OMB No 20509{Expires 9 30-94) See Instructions on bf J'OA* Deportment of Toxic Substances Control <br /> .�..Zot or type Form designed For use on old*(12pdch)rypewrrter Sacramento California <br /> JV3 <br /> NIFORM HAZARDOUS I Generator s US EPA ID No Manifest Document No 2 Page 1 Information in the shaded areas <br /> a not required by Federal law <br /> WASTE MANIFEST 1 5 9 0 � 0 4 I ° �� �� <br /> rator s Name and MailinAddressin NNA GARDNER PROPERTY - '-�; o� <br /> 16096 THORNTON RD. , TdOANTOX, CA. - 9568(1 _ � r� •� � ���„ ��# � "��� <br /> in 4 Generator's Phone (2 0 g) 838_3507 <br /> d 5 Transporter 1 Company Name 6 US EPA ID NumberAw <br /> T s I [ z <br /> O �€ <br /> w <br /> PETROLEUM RECYCLING CORP. ' � 2-WR' <br /> Q 7 Transporter 2 Company Name 8 US EPA ID Numberit <br /> � s Fr porgy Y - t t #- <br /> �r <br /> U p esr'i Phoria �� �r JS <br /> Q 9 Designoted Facility Name and Site Address 10 US EPA ID Number Gc" IF fs ID;q �. S <br /> PETROLEUM RECYCLING CORP. ? <br /> 13331 N. HIGHWAY 33 I,fewidy'sPhone _ , <br />�U PATTERSON, CA. 95363 ` <br /> 11 US DOT Description(including Proper Shipping Name Hazard Class and ID Number) LL_12 Containers 13 Total 14 Unit <br /> OZ No T Duan Wt/Vol <br /> 13 a OIL, WATER NON RCRA HAZARDOUS WASTE LIQUID <br /> G ' <br /> 01 01 1 11 T 0 Itd G <br /> Amet-ra7eurn mecycling Corporation certifies that the above f'nntion <br /> BA ste(s), more specifically identified by reference to the waste manifE st <br /> , t forth above W <br /> e p�ovlslonsLof 40CFR261 6 and 23 4 pursuant to 40CF 261 3( ) , <br /> } hazardous-waste generated from the recycling efforts s I o <br /> W <br /> t-- d <br /> Z <br /> PETROLEUM RECYCLLNG CORP RATIO <br /> 0- <br /> U) <br /> fE <br /> Z 15 Special Handling Instructions and Additional Informahon <br /> a 24 HOUR EMERGENCY CONTACT: PRC/ENVIROPUR (800) 574-4444 <br /> Z 24 HOUR EMERGENCY RESPONSE: CHEM TEL INC. (800) 255-3924 <br /> w <br /> = WEAR APPROPRIATE PROTECTIVE CLOTHING AND RESPIRATOR <br /> t— <br /> 16 GENERATOR'S CERTIFICATION I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping nine and are classified <br /> �acked marked and labeled and are in all respects m proper condition for transport by highway according to applicable federal state and international laws <br /> a , <br /> V <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 /> economically practicable and that I have selected the prachcabie method of treatment storage or disposal currently available to me which minimizes the present and future <br /> a threat to human health and the environment OR if I am a small quanMy ge7rator�I have made a good faith effort to minimize my waste generation and select the best <br /> en <br /> wrote mane afford management method that is available to me and that I can aord <br /> W Month D Year <br /> O PrintedlTyped Name ` SignaNre 1 ! C aYf <br /> >. J2U rPlr✓f r i .< 111 Sri L _'g ? ' �. <br /> V T 17 Transporter 1 Acknowled einem of Receipt of Materials <br /> CLJAn P /Ty d Name n Si Morrth Day Year <br /> NS le �L 4r,, 4,_ <br /> 0 116 Transporter Acknowled ement of Receipt of Materials <br /> W 7 Printed/Typed Name igriahtre Month Day Year <br /> 0 S <br /> e <br /> W 19 Discrepancy Indication Space <br /> an <br /> U A <br /> Z C a <br /> 1 <br /> 20 Facility,Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted on Item 19 <br /> T Printed/Typed Name Signature { Month Day Year <br /> DO NOT WRFrE BELOW THIS LINE <br /> Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> DTSC 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 DTSC within 30 days) <br />