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cre atColifernio—EnnronmeMalProtectionA,., (r <br /> m Approved OM8 No.2050-0039(Expires 9-30-941 See Instructions on back of page 6. Department of Toxic Substances Control <br /> lase print or type. Form designed(or use on disc(12pitc h)typewriter. Sacramento,California <br /> 10 <br /> f 1. Generato S EPA ID No. Manifest Document No. . Page 1 Information in the shaded arms <br /> UNIFORM HAZARDOUS is nor required by Federal w <br /> WASTE MANIFEST CAC 0 0 0 9 7 0 4 1 6 0 0� O 0 2 1 of 1 1 <br /> ! 3. Generator's Name and Mailing Address q State Manif st Document Nm <br /> i I CITY OF TRACY 520 TRACY BLVD. x : , 3.1939�Z <br /> I TRACY, CA 95376 ATTN. PAUL VERMA a State Gee at�or,lD <br /> . Generator's Phone (209) 836-4420 ., <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C State TrvmpoAer IO s 9' <br /> � � � -rte : <br /> PETROLEUM RECYCLING CORP. C T 0 0 0 1 0 9 D T a ,po er s Ph. <br /> s *e <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Trar_uporters jR fl �r s r <br /> i 3,� r <br /> IN <br /> F. Transporters Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G State Fadliry's ID SWISS <br /> RECYCLING CORP. 0 3 .1 6 7 8`;, �;�,. ,;Y <br /> 13331 NORTH HIGHWAY 33 H. FadOry's Ph.me, kS x <br /> PATTERSON, CA. 95363 1 W 98 6 24800-874-4444 <br /> 12. Coneainers 13. Total 74 Unit <br /> ?+ <br /> 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) 12. Type Quantity 14. Vol I.'Waste <br /> NON RCRA HAZARDOUS WASTE LIQUID <br /> E (WATER, OIL) 101011 T 10111SIt Q J G evA/ ` <br /> r`x - <br /> N b. Stpte - 'i�zifir� <br /> R EPA/Othm s€ a.Yi - <br /> T c. state a4 ,.S ala <br /> Rd. <br /> EPA/OIMrti �3A -e <br /> E1.h}Y - <br /> "3,` a 4 <br /> EPA O" <br /> vY15� <br /> ' AdsGeogolC <br /> Deseitptions forMateaab fitted Abowti s y 'yam—'^ - "! 3 is'� ndbag odes for Waites Usted Qbo <br /> K Ha <br /> aP -: <br /> s ty�� F r' t'a'��oX arx .^.i _ �' �.• Y n It -Ysn-'aoLyT mak-;" �a ..3 -cit' �7` . <br /> A �6.• <br /> y�.. 'R�#- -s"Yr} �. •y-d`sSv�-:.�v' ..1 .+rJ-r`Y v +.. '�": '.Lx,i��5.r ,s��» <br /> 15. Special Handling Instructions and Additional Information <br /> SITE: 10 W. GRANT LINE U. <br /> 24 HR. EMERGENCY CONTACT: 1-800-874-4444 TRACY, CA <br /> 24 HR. EMERGENCY RESPONSE: CHEM TEL INC. 1-800-255-3924 <br /> APPROPRIATE PROTECTIVE CLOTHING 5 RESPIRATOR <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the 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 federal,state and international laws. <br /> If I oat o large quanfity 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 practicable method of treatment,storage,or disposal currently available to me which m'nimizes the present and future <br /> threat to human health and the environment;OR, if I am a small quantity generator,.{have made a good faith effort to minimize my wastegeneration and select the best <br /> waste management method that is available to me and that I can afford. / / / r f <br /> ' <br /> Printed/TypedSignawze.—"� r/ ✓i/ Month Day tFej <br /> i3 <br /> r 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> TypaLLd,1Name q O n) 5i rl fsfo O r� <br /> o . Tronsaorter 2 Acknowled ement of Receipt of Materials <br /> I Printed/Typed Name signatureMorth Day Year fF[ <br /> t <br /> I R <br /> 19. Discrepancy Indication Space <br /> f <br /> I p <br /> I C <br /> I 20. Facility Owner or Operator Certification of receipt of hazardous matertals covered by this mumif.st exceor as noted in uem 19. <br /> T -inted/Typad Noma SignatureMonth Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS UNE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> SC 8022A (7/92) To: "C. 3cz A00, Sacmmeraa, CA 95812 C400 <br /> 8700-22 <br />