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r <br /> NOR-CALQL tick of U, 6. Department of Toxic Substances Control <br /> P.O. Box 6455 Socromanto,iCalifornia <br /> D E;N A I R, CA 95316 Kument No. 2. page I Information in the shaded areas <br /> is not required by Federal law. <br /> 1-800-332-8710 7 l3 of I <br /> E.P.A. CAD 982417255 �� <br /> CUSTOMER' S ORDER NO. �i52-45Es1 °"736!24/94 <br /> NAME JIM THORPE CIL, INC. <br /> ADDRESS 7a'..,1 <br /> .. N. HECi•:I•'iAN R.,D <br /> _ t ^J <br /> J 1d r <br /> LODI, CA 95240 <br /> ZZI <br /> EPA a s <br /> CAL000012eS4 g} � <br /> �onloiners 13. Total 1/. Unit ',g`k.?;�;,;1rts` }t .'y`r <br /> WASTE WATER/RINSATE 7 e Quanti Ws/vol !, <br /> WASTE ETHYLENE GLYCOL1 <br /> `3 <br /> TEST —� ; T T (i <br /> USED OIL FILTERS-DRAINED 24 HRS. <br /> SLUDGE y a qtr A <br /> II, I <br /> i <br /> S.M.D.N. a <br /> _ h <br /> SHIP TO: <br /> PAC ROMIC CHEMICAL CURP.� <br /> 13331 N. HWY. 33 2081\BAY ROAD <br /> \ I described above by proper shipping name and are classified, <br /> I applicable{adoral,state and international laws. <br /> PATTERSON, CA M63 E, PALI) A��CA 94303 <br /> E.P.A. CAD083166728 E.P.A CAD009452657 I TAXty of waste generated to the degree I have determined to be <br /> �rrently available to me which minimizes the present and future <br /> lith effort to minimize my waste generation and select the best <br /> SIGNATURE ✓s <br /> l j TOTAL Mont Po <br /> y ear <br /> 7 36L <br /> Monlfj Day Year <br /> (J�� <br /> 0 18. Tra s orter 2 Ac wled emenl of Recel t of Materials <br /> I Printed/Typed Name Signature HMonth Day Year <br /> l4 , <br /> O � <br /> UJ 19. Discrepancy indication Space <br /> sn p <br /> Q F <br /> V A <br /> z <br /> 1 <br /> 1 20. Facility owner or Operator Certification of receipt of hazardous materials covered b this manifest etre 1 as noted in Hem 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO .NOT WRITE BELOW THIS LINE. <br /> bTSC 8022A (7/97) <br /> EPA 8700-22 f.�ll.rrr r Ilflat4l� �I. kl'1A.'h15. <br /> 1 <br />