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State of C-alifa gio .Environmental Protection Agency ' <br />Fort /� p-oved OMS Nq�2050-0039 (Expires 9.30-94) <br />Pleasrl im or type. Form designed for use on elite 12 -pitch) <br />�`. <br />� e Instructions on back of -- ge 6. Department of Toxic Substances Control <br />iter. Sacramento. California <br />- <br />r <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. <br />Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />CAL000892776 <br />0080 U i <br />of 1 <br />is not required by Federal law. <br />-- -4 <br />3. Generator's Name and Mailing Address ANDERLANS & SONS <br />1320 S. SACRAMENTO <br />A. StotA Manifest Document Numbe •� <br />- <br />4 <br />t <br />!ODI, CA. 95240 <br />ST. .i <br />e. s1Me Generator's ID <br />4. Generator's Phone ( 209 334— 411_,,,i <br />t i <br />s� �s..rA.� <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />Stas,, Traasp/fie f t ID <br />C4rWflo <br />ji II / S Transporter s�hglm Y� <br />7. Transporter 2 Company Nome 8. US EPA ID Number <br />Staff) Transporter's IDE .. 1 <br />6-k-j� �.�— C s -r /�:�^ ~� iT(�% I [ S 1 11C v) <br />C( Transporter's Phorre, <br />/ f <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />State Facility's ID <br />PETROLEUM <br />RECYCLING CURP. <br />'PSP PI._5 1^1_1 j 1 <br />1835 <br />EAST 29TH STREET <br />_f <br />FaciYty's Phone <br />SIGNAL <br />HILT, CA, 90806 CAt 686 bit 65il <br />1 1 1 1 1? —24111131 <br />US DOT Description (including Proper Shipping Name, Hazard Class, and ID. Number) <br />12. Containers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/vol <br />I. Waste Number <br />No. <br />Type <br />WRSTE PETROLEUM OIL COMBUSTIBLE LIQUID SVA 1270 <br />D r; <br />E <br />RECYCLING CERTMC�►'PE <br />U U 1 <br />.� <br />Othert'�/ <br />N <br />b• <br />p <br />E <br />Petroleum Recycling Corporation certifies that the <br />R <br />waste(s), more specifically indentified by <br />EPA/Other , <br />A <br />above menticned <br />T <br />referenc3 to the waste manifest set ortabove, was/were <br />_. <br />State <br />0 <br />in accordance with the provisions of 40CPF261.6 <br />R <br />recycled <br />and 26.4 urs --ant to 40CFR 261.3 (c) (2) hazardou:..taste <br />EPA' acts@` <br />9*nerated from the r -,cycling efforts was also recycled 1n <br />State —� <br />accordance viit'-i the provisions ^f 40CFR266 ijubpart D <br />_,e _ <br />EPA i (ether <br />I <br />�, Addrtionaf 7�{�Ls gl �COR RATION <br />K- Handling Codes for Wastes' listed A6cwe <br />189. <br />r ; <br />I <br />I <br />c.t d <br />15. Special Handling Instructions and Additional Information <br />4• -HR. EMERGENCY CONTACT: 800-874-4444 <br />4 HR. EMERGENCY RESPONSE: CHEM TEL INC. 800-255-3924 <br />APPROPRIATE <br />PROTECTIVE CLOTHING & kESPIKATOK <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 am a large quantity generator, I certify that I have a program in place to reduce <br />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, <br />storage, or disposal currently available to me which minimizes the present and future <br />threat to human health and the environment; OR, if I am a small quantity generator, <br />I have made a good faith effort to minimize my waste generation and select the best <br />waste management method that is available to me and that I can afford. <br />Printed/Typed Name <br />Signature, <br />Month , Day Year <br />� <br />7 <br />1 r <br />- <br />T <br />17. Trons rte 1 AcknowI ement of Receipt of Materials J <br />R <br />A <br />Printed/Ty Name <br />Signature <br />Month Day Year <br />S <br />r� , <br />;?4L� <br />6n/- <br />0 <br />— <br />18. runs ' rter 2 Acknowledgement of Receipt of Materials' <br />- <br />T <br />Pri d'f//T��yy`ped Nama /��\ (� •. <br />Sig rs�.- <br />( <br />/ nJjrDay Year <br />19. Discrepancy Indication Space <br />IF <br />A <br />C <br />1 <br />t <br />1 <br />20. Facility Over or Operator Certification of receipt of hazardous materials <br />covered by this manife t except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year , <br />DO NOT WRITE 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 />