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. r c� scute ai Caklema—enwr«,msmal Pm!esm n Agency 'fir. �u �struetions on back doge 6. Deparm m,.1 To..sabem"..Car..d Form Adprewd OMR No.3030-0039(EWvw 9-30-94) 13 M Sasran.ea,Calif .a •'� Plage gee er MP. Fwm a.,med to are on.life f ITpisNl 1. Gesseratei s US EPA ID Na. Manilea Document Na. 2. Pogo 1 Inlorm�Nen in die shaded cram UNIFORM HAZARDOUS "ne"esn'red by Federd tew. WASTE MANIFEST (.10 10 1 Q 17131q 1013 161 I)l of 1 3. Gene,shm's Name and Moiling Address I A' Slate Arar0.0 Dacaseem Mfrn - n ESTATZ Jr 4ILLI.41S S: HANSON 3 ' n 45 iiliNTER SQ. PLAZA. STOC:CTON, CA. 9520 IB 5 a Generab'a lD a. G.n.aro'sPAen. I;U91465-5623 ' h S. Transporter 1 Company Nome 6. US EPA ID Number C. Sete Trar"poner's ID !� PETROLEUM RECYCLING CORP. w 44 `I 7 TrssnsporM 2 Company Norse a. US EPA ID Number - s,9ateTrampafee✓a ID .tin Tra"pode/a Phare '.ei s „ �a _jTchmignated Facility Name and Sim Address 10. US EPA ID Number G• Srote FaaW&l0, �Z PRC PATTERSON, INC. ' ne 13331 N. HWY 33 KF11 i:: y CV a PATTERSON, CA. 95363 pU 12. Cmmamen 13. Total lt. UM11. US DOT Description(including Proper Shipping NemT s.Hazard Class,and ID Number) No. QsamHy Wt/Vol OIL, WATER NON RCRA HAZARDOUS WASTE LIQUID ? U 3 ',CCAeLbae jj no' E m E •ta'Ptr012U1Y, ReCyCitrly l.UO.;UIui,Ul� .:e(llllci ".;'1 '9 me tione R 'aste(s), more specifically identified by referer Tne a t an fe , A t I I d s were Iecvc e ;o danc ti o -Isions of 40CFR261 .6 ar!c 2'; CFP? R _ardous waste enerated frrr In accordance with the -:ovi Z s. .r �'�; 6 Sub PETROLEUM RECYC -'C R R r f .N - ( Z r O ! 6 f N W O15. Special Handling Instructions and Additional Information a 24 HR EMERGENCY CONTACT: PRC PATTERSON (800) 874-4444 Z 24 HR EMERGENCY RESPONSE: CHEM TEL, INC. (800) 255-3924 F WEAR APPROPRIATE PROTECTIVE CLOTHING AND RESPIRATOR 16. GENERATOR'S CERTIFICATION: I hereby declare than the comms of this comignn a are fully and accurately described above by proper shipping nem,and aro classified, Qp«ked,marked,and labeled,and are in allrespectsin proper condition for transport by highway according to applicable international and national gowmment roaulatiore. U � If I am a nage quantity generator, I cerciry that I bare a program in place to reduce the wrvme and toxicity of•-ante generated to the dagree I hcve datarmkmd to be economically practicable and Mat 1 haw selected the practicable methal of treatment,storage,or disposal currently available b me which minimizes the present and future n 0- threat ho human Mahh and the emironmem;OR, E 1 am a small quomiy generator,I haw made a good faith effort to minimize my waste generation and select the best yl waste management method that is a ilab to me and that I can afford. r 0 Fy,�ted/Typed Nm^° ,, II nwlure MOMh Doy� %ao� ry >;StRt� gF b1AUSot� 1• �O`'hc�e S� , al.�• Z t 17. Transport 1 Acknowi al .meet of Receipt of Materials t wFE, Pri T I'Im m ro Alonrlh Day Year f P�C� !9 �. u, s A 0 III.-Transpother 2 AcknoMed em oll of Receipt of Materials W T Printed/Typed Nene gnature Momh Day Year O s ly 19. Discrepancy Indication Space Is Z i C- +tA4 ( vG � � U� S 3 � - k 20. Facility Owner or Operator Certification of receipt of hazardous materials mwred by Mumifest exce t m din Hem 19. T Pri /Typed Nene Signe Month Day Year • // d3 oG9 A e nre e C/O IncCD r NOTE.t Sgcbmi Htd b 6� DO NO RI W IS UNE. DanwQ� D. 13esacae� ff Tallow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. mac 0022A(9/93) �' (Ganeraton who submit hazmdous wrote for trvrspod asbf+rota, EPA 8790-•72 produce completed copy of this copy and and has DTSC within 30 days.)