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M1 <br />I <br />5100 01 Cahfo rso—Eminnmentol Protection Agency <br />Form Approved OME No. 2050-0039 (Expom 9-3094) See Instructions on back of page 6. Depaament of Toxic Substa c., Carnal <br />Phot print or type. Form designed far uu on elite /12 -pi oewrimr. <br />UPI Nut YIIRIIe BELOW THIS LINE. <br />MAC sm,'A <br />G.een: itf4��PVRIEH Rt TAINS711IC <br />_ <br />UNIFORM HAZARDOUS 4, Genaralo: s US EPA ID No. Manifest Documl or4c, <br />..mrammro 'a iss'. <br />2. page 1 <br />Information in she shaded areas <br />WASTE MANIFEST <br />not required by Federal low <br />rT <br />of <br />3. Immensities Nome and Mailing Address <br />A:; gyp{+AMN(nt DocuimM - <br />$ <br />TERESI TRUCKING, INC. <br />134 96 <br />P. 0. Box 1270, Lodi, CA 95241-1270 <br />E.' s�raTPwy'e.o <br />4. I mentio: s Phone (209) 368-2472 <br />aS. <br />Tronsporter 1 Compony Nom, 6. US EPA ID Number <br />NOR CAL OIL ICAD 19 18 12 141117 12 15 15 <br />°° (209) 667-"92 <br />7. Trompoder 2 Company Name 8. US EPA ID Number <br />U <br />Q <br />•' TFpnyetgl'slAore - <br />Z <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />0;,&IID <br />PRC PATTERSON, INC. <br />13331 N. Hwy 33 <br />Frntpte <br />RAttercon. CA 95163 ICJA 11) 10 18 11 <br />(800) 874-4444 <br />Z : <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />I Containers <br />13. Total <br />14. Unit <br />No. <br />T <br />`- <br />NON-RCRA HAZARDOUS WASTE LI1M <br />Guam <br />V <br />VI <br />I. Waste Number <br />��` <br />1; <br />(WATER & OIL) <br />223 <br />EPA/OA r <br />r E <br />0 0 1 <br />T T <br />0 3' 7 5 <br />1 <br />P <br />b. <br />E <br />stl <br />v R <br />A <br />EPA/ONer <br />T <br />O' <br />--- -- _— — <br />a <br />e N <br />� <br />EPAlOIM.- <br />i <br />d. <br />Slide <br />EPA/OR" <br />I! <br />J. Additional Descriptions for Materiob Listed Above <br />K. Handling Codes for Wasters llasd Above <br />TANK BOTTOM WASTE <br />RINSATE <br />C. <br />d. <br />13. Special Handling Instractions and Additional Information - - <br />APPROPRIATE PROTECTIVE CLOTHING, <br />"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 cansignment ore fully and accurately described above by proper shipping name and an classified, <br />packed, marked, and labeled, and are in all respects in proper condition for tro part by highway according to opplicobk international <br />and notional government n galolians. <br />If I oma large quamity generator, I cemdy that I have a program in place to reduce Me volume and toxicity of waste generated to the degree 1 have defermioed to be <br />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which the <br />minimizes present and future <br />Mrem to human health and the environment; OR, if 1 am o small quantity generator. I have made a good faith effort to minimize my waste generation and select the best <br />waste mane ement method that is available to me and that I can afford. <br />Primed/Typed Name c ar—r10r'p@ agen Or SigroNre <br />Year <br />W <br />7eresl Truckln ,Inc. !' , 1 1 3D 0 <br />T <br />m <br />17. Tram ar I Acknawled einem of Racei t of Ma4riols <br />♦ <br />" <br />Printed/T ped teome <br />JOEL PUETT <br />Signature r' <br />° 6. / T �%' M°^R Day Year <br />f'. 1 3 0 9 5 <br />0 <br />mose <br />18. Trans er 2 Acknowled —m of Recti 1 of Maseriak <br />i <br />Prinled/Typed Name <br />Signature <br />A1omh Day year <br />� <br />19. Discrepancy Indication Space <br />F <br />1 <br />20. Facility Owner or Operator Gasification of recti t of hazardous stamen. Is <onre Mit manifest exca t as nated in Item 19, <br />s <br />T <br />Primed/Typed Horne <br />'. <br />" <br />7llr-v Oliver <br />Signahue" - <br />� � ��r�e *� G <br />_ <br />.:t 1 / <br />UPI Nut YIIRIIe BELOW THIS LINE. <br />MAC sm,'A <br />G.een: itf4��PVRIEH Rt TAINS711IC <br />