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r <br /> Store of Ccifif—io—Environmental Protection Agency <br /> Form Approved OMB No.2050.0039(Expires 9-3094) See Instructions on back of 3e 6. Dep—merit oI Toxic Substances Control <br /> Pi—e print or type. Farm designed for use on elite()2-pitch)typewriter. Sacramento,California <br /> UNIFORM HAZARDOUS71Geno,oto,'s US EPA ID No. Manifest Document No 2 Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> rt <br /> WASTE MANIFEST of <br /> At <br /> C1 Al C1 0101 112131114101 -81 11 11 Q R I A <br /> 3. Generator's Nome and Mailing Address A. State Marsifest Documentumber <br /> h LEROY METTLER X513 988 <br /> 13939 N. Alpine Road, Lodi , CA 95240 & State Generator's ID <br /> CN .. Generator's Phone (209 369-£3524 <br /> 00 <br /> 6 5. Transporter I Company Nome 6. US EPA ID Number C. Stole Transporter's ID <br /> 00 <br /> 00 D. Transporter',Phone <br /> 7, Transporter 2 Company Name 8. US EPA ID Number E. Stott Transporter's ID <br /> Q <br /> U F. Transporter's Phone <br /> 0a 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Stole Facility's ID <br /> ODIx PRC PATTERSON. INC. In I A I Q101 111131116 111171 61 <br /> M° 13331 N. Hwy 33 H. Focib 's as ^ <br /> �Q CAD083 667 fl <br /> MU 12. Containers 13 Tota N Cnir ) <br /> _1Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> rl No. T Quantity Wt/Vol I. Waste Nurnbe, 10 <br /> a.�~ NON-RCRA HAZARDOUS WASTE LIQUID ,rote223 ;17, <br /> Q�3 G (ANWATER & OIL) <br /> 6i E 01011 dl c 0111' G EPA/aMr it <br /> oco) N b, Stale <br /> N R EPA/Other <br /> A - <br /> o T C. State <br /> 00 � <br /> R EPA/Other <br /> IYrim <br /> w <br /> l— d State .4 <br /> Z <br /> LU <br /> U EPA/Other <br /> L I --- .: �.w <br /> I� Z J, Ailditignal Deycriptigns for Moterioll listed Above K. Handling Codes for Wastes Listed Above <br /> 0b.BOTTOM WASTE b. <br /> U-1 RINSATE t <br /> d. > <br /> O15 Special Haridling Instructions and Additional Information <br /> a APPROPRIATE PROTECTIVE CLOTHING <br /> Z "EMERGENCY CONTACT: (209) 667-6692" <br /> = SEE E.R.G. PAGE 31 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this 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 international and national government regulations. <br /> Q <br /> U <br /> J II 1 am a large quantity generator, I certify that I hove 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 hove selected the practicable method of treatment, storage,or disposal currently available to me which minimizes the present and futare <br /> d threat to human health and the environment;OR, if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best <br /> N waste management method that is available to me and that I can afford. _ <br /> OPrinted/Typed Nome Richard Thorpe agent for Signciture Month Day Year <br /> } <br /> Leroyt+lettl er ` +,l • :; <br /> U y 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> Z e <br /> LU A Printed/Typed Nome Signature -- _ Montt Day Year <br /> L! <br /> r <br /> o I8. Trans otter 2 Acknowledgement of Receipt 0l Materials <br /> w T Printed/Typed Name Signature Month Day Year <br /> LL E t <br /> ° e <br /> LU 19. Discrepancy Indication Space <br /> VI <br /> < F <br /> U A <br /> Z C <br /> L <br /> I 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (9/93) Yellow; GENERATOR RETAINS <br /> EPA 8700-22 <br /> i <br />