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State of California--=Enviroronertal Protection Agency <br /> Form Approved OMB Nm4050-0039(Expires 9-3494 <br /> Please prior. ] If, See:Instructions on back of e 6, <br /> 'type. - Form designed for use on elite(12.pitch)rya,,wirer. - Department of Toxic Substances Control <br /> Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's U$EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST is not required by Federal law. <br /> t of ]' i <br /> 3. Generator's Name and Mailing Address <br /> ' �t - 'ns e3t�':Dgcu T-.t,�•!u„ a .. € j <br /> CANTEEN CORPURATION �, w <br /> An <br /> ; 4"V - <br /> N 1500 SHAW ROAD, STOCKTON CA 95205 � I <br /> 4. Generator's Phone ( ] <br /> SFht@z er` Jf9 <br /> 47 A7r,7 <br /> OD <br /> 4. <br /> Op S. Transporter 1 CompUL <br /> any Name 6. US EPA ID Number. 4. o• �� : i <br /> co <br /> a . { <br /> PETROLEUM RECYCLING CORP. 9 <br /> QJ > <br /> 7. transporter 2 Company Name 8. US EPA ID Number. <br /> V 3: 1Efitaie'Tfan;pa <br /> 1. <br /> v 0. <br /> Z 9. Designated Facility Name and Site Address 10. US EPA ID Number (, SeG11 = 471 s Tf)a k j <br /> PETROLEUM RECYCLING CORP. t <br /> I <br /> n = 13331 NORTH HIGHWAY 33 <br /> Y) U �f; 9k I I I <br /> 11. US DOT Description(including Proper Shipping Name,Hazbrd Class,and ID Number] 12. Comoiners 13. Total 14. Unit <br /> Z No. T e Quantity Wt/Vol <br /> F– a. ; <br /> 3 fate; t <br /> G <br /> c� E TQjjTht r _ I <br /> coo N b. Wirw <br /> W E HYD OCARBONS) <br /> R I � <br /> v A <br /> o T <. <br /> R E <br /> �Uj <br /> 1pa� <br /> ., <br /> Uj <br /> LU <br /> qw- <br /> . . <br /> O d?ahaAft "AbgY <:>a�aiidlCges'f23niY�a <br /> a t <br /> Z <br /> O 15. Special Handling Instructions and Additional Information <br /> a1I <br /> Z 24 HR. EMERGENCY CUNTAL-T: 800-'874-4444 ! I <br /> w 24 H$. EMERGENCY RESPONSE: CHEM:TEL INC- 1840--255-3924 <br /> x t : <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 /> Q packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,stale and international laws. <br /> V i . <br /> If I am a large quantity generator, I certify that I have al1program in place to reduce.the volume and toxicity of waste generated to the degree I have determined to be t <br /> aeconomically practicable and that I have selected the practicable method of treatment,storage,or disposal currently ovailoble to me which minimizes the present and future <br /> sn threat to human hea% 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 1 <br /> Cr <br /> waste management method that is available to me and that I can afford. <br /> Q Printed/Typed Nome _ A, Signature r Month Dory Year i <br /> Z t 17. Transorter 1 Acknowled ement o ecO,t of Materials <br /> u_t R <br /> Cr N Typed Nome. S we ! l Month Day Year I <br /> LUIn 10 12 <br /> liJ v ' i <br /> 0 18. n rter Acknowled ement of Recei t o Materials <br /> w R f � <br /> T Printed/Typed Name Tinbtur. <br /> Month Day Year ' <br /> LL O R <br /> LU 19. Discrepancy Indication Space a <br /> Q F <br /> V A <br /> Z L <br /> 120 Focili Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year E <br /> Y {{ <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (7/92) € <br /> EPA 8700-22 - � p <br /> p Yellow: GENERATOR RETAINS ! <br />