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a � <br /> State of Colifornio—Emironmenial Protection Agency <br /> `Form Approwd OMB No.2050-0039(Expires 9-30-94) See Instructions on back of e 6. Department of Toxic Substances Contro4 'II <br /> Please prF!type. Form designed for use on alite(;Zpirchf ye ..r. 13 SacromenTo,Colifornia(1,"f p <br /> + 1. Generator's US EPA ID.No. Manifest Document No. 2. Page 1 information in the shaded areas jl <br /> UNIFORM HAZARDOUS �, is not required by Federal law. fl <br /> WASTE MANIFEST C 1. 0 0 0 9 4 18,15 2 8 0 3 4 ' 4 7 1 of l <br /> 3. Generator's'Name and Mailing Address A tat lr on" ;f`Q - meltf-N,u r i <br /> CANTEEN CORP. ` ': i <br /> tO <br /> ` 1500 SHAW ROAD STOCKTON, CA. 195205 <br /> I <br /> L0 4. Generator's Phone (2091 847 $757 <br /> co <br /> p 5. Transporter 1 Company Name :i 6. US EPA ID Number <br /> C> <br /> I. aoIC IAIT 10 IS 101,01111101519 <br /> i _ 'partefs Pho" I <br /> PETROLEUM RECYCLING CORP, <br /> Q7. Transporter 2 Company Name 8. US EPA ID Number p rtei?s <br /> r. z 9. Designated Facility Name and Site Address I, ii 10. US EPA ID Number SfvTe :oc+Irr, 19J .. '� <br /> h o PETROLEUM RECYCLING CORP. <br /> n " 1835 EAST 29TH STREET <br /> --i a I <br /> V - 12, Containers. 3. Total' " 14. Unit <br /> ..,^ - ! <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> No. I jXpe Quantity Wi/Vol _- <br /> aNON RCRA HAZARDOUS WASTE SOLID j <br /> G (SOIL, TRACE GAS) D `4 G <br /> E <br /> co N b. 4 <br /> E ' <br /> N R IS r <br /> 0 <br /> A <br /> 00 O <br /> a RLLJ <br /> e" <br /> Z d. <br /> i V r .1«~x•, i <br /> � F ,l I <br /> Z or! at alb'f z}' ( , eta [frig, " ,gas: c ostia. <br /> OCL <br /> LU <br /> Z <br /> O 15. Special Handling Instructions and Additional Information <br />' a 24 HR. EMERGENCY CONTACT: 80 <br /> Z 24 HA. EMERGENCY RESPONSE: C <br /> ,,74-4444 <br /> TEL INC. 800-255-3924 <br /> = APPROPRIATE PROTECTIVE CLOT4G & RESPIRATOR <br /> J 16. GENERATOR'S CERTIFICATION: I hereby d I9-r that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q packed,marked,and labeled,and are in alltr'y in proper condition for transport by highway according to applicable federal,state and-international laws. <br /> U i <br /> If I am a large quantity generator, I certify that l have a program in place ito reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> J economically practicable and that I have selected the proctica6le method of treatment,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, 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. ` I <br /> O Printed/Typed(flame fp / Signature' / I Month Day Year j <br /> Z T 17. Trans rter 1 Ackn=jedgement of Receipt of Materials r I <br /> w n Print ed me Sign //- M nth Day ar <br /> " <br /> Uj< 5 I <br /> C P <br /> 0 18. Transporter 2 Acknowled ement of Recei t of Materials' <br /> f4' T Printed/Typed Name Signatures Month Day Year <br /> U- <br /> O Ft i <br /> W 19. Discrepancy Indication Space I <br /> u7 <br /> Q F <br /> V A I <br /> Z C ,•.� <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by.this manifest except as noted in Item 19. I <br /> T Printed/Typed NameSignature Month Day Year <br /> y _.. .I <br /> i <br /> DO NOT WRITE BELOW THIS LINE. <br /> I <br /> DTSC 8022A (7/92) <br /> r EPA 8700-22 j Yellow: GENERATOR RETAINS <br />