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iNOR-CAL OIL oak of Page 6 Department of TORIC Substances Control � <br /> P O sox 646 Sacramento Collforrea <br /> rcument No 2 Page I Information in the shaded areas <br /> D E NAI R, CA 95316 is not required by Federal low <br /> 1-avv-332-f;71v /�/� 0 7 9 of ] <br /> E P A. CAD 982417255 !�,(f L� <br /> ER s oRDEIa NO 02" 462-45$1J "J6/2Q/94 <br /> E JIM THORPE OIL, INC. <br /> OR Ss 17 <br /> —51 N. BECKMAN RD. <br /> I <br /> L©DI, ::A 95240 � lull, # <br /> A e t! <br /> CAL000012e84 <br /> ��` DESCRIP7]ON -'�— PRIG <br /> �onlamers 13 Total 11 Umt •er L 17 ', <br /> WASTE WATER/RtNSATE Type Quante Wt/Vol <br /> WASTE ETHYLENE GLYCOL {• {' <br /> ITT <br /> TEST (i <br /> USED OIL FILTERS DRAINED 24 HRS I <br /> SLUDGE r <br /> v <br /> t <br /> SHIP TO <br /> PRC ROMIC CHEMICAL CORP <br /> 13331 N HWY 33 2081\BAY POAD <br /> \ I described above by proper shipping name and are classified <br /> PATTERSON CA 95363 E PAM- ALI CA 91303 applicable federal state,and mternalwnat laws <br /> EPA CAD483166728 EPA CAD009452657 I {!�( I ty of waste generated to the degree I have determined to be <br /> rrenlly available to me which minimizes the present and future <br /> SIgNATURE nth effort to minimize my waste generation and select the best <br /> TOTAL Monr Day ear <br /> Mons Day Year <br /> I p1 c <br /> s1zI I t Xe <br /> 0 18 Tr sorter 2 Acknowled emenf of Receipt of Malenals <br /> jPrinted/Typed Name Signature Month Day Year <br /> it <br /> LL e <br /> O <br /> w 19 Discrepancy Indication Space <br /> to <br /> A <br /> Z C <br /> I <br /> l <br /> 1 20 Facility Owner or 2earator Certification of recel I of hazardous materials covered 6X this mandest except as noted In Item 19 <br /> T Printed/Typed Name Signature Month DW Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE <br /> DISC 8072A 17/92) <br /> EPA 8700-22 n H�.r I I IIiI�Ai�4 Ht IAlt15 <br />