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/ ,lel Protection Agency <br />/ ,i0-00391tzpires 9.30-991 /. See Instructions on back of page 6. Department ul Toxic Substances Control <br />.designed fort we on alit. (12 -pitch) lype,vrlfec Sacramento, California <br />/,/ORM HAZARDOUS <br />1 • Generator s. US EPA ID No. Manifest Document No. <br />2. Page I <br />Information in the shaded areas <br />/ <br />is nal required by Federal law. <br />WASTE MANIFEST <br />7 <br />,( <br />aerator's Name and Mailing Address e <br />S ��er sl r(�bh <br />A. State Manifest Document Number <br />21142747 <br />r I; nl::h AVC a <br />B., Stale Ge7aruters ID <br />4. Generator's Phone -.I J`, - '/ 5t'. s <br />5. Tronsporlerl;Company . ,omen .� 6. r US EPA ID Num66r - <br />.. a <br />C. Stale Transporters to )Reserved.) <br />(s <br />ti stICAN VALLEY WASTE OIL t ' i p 7 S <br />D. Tansporter', Phone Wye.732.4646 <br />7. Transporter 2 Company Nome 8.: US EPA ID Number <br />E. Stale Transporter's ID (Reserved.) <br />F, Transporters Phone <br />rs Rq pq?!jrf ejgAN Manu i6N and Site Address 10. US EPA ID Number <br />G. Sial a i ty' ID <br />b <br />PNVI <br />g a 2 S s 11 a: <br />:$.ai ALMOND UR. <br />11131 <br />H. Facilitys Phone <br />1LVER SPRINGS, NVO9429 y y PIg 2 P P 181418 P <br />702-5717-017.01 <br />11. US DOT Description (including Proper Shipping <br />p I' g p Aping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14. Unit <br />- <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I: Waste Number <br />NON•RCRA HAZARDOUS WASTE LIQUID <br />slot. 229 <br />(OILY WATER� <br />U 0 1 <br />7 T <br />, <br />EPA/oth.. <br />b. <br />Stale. <br />EPA/Other <br />EPA/Other- <br />d. <br />$lald <br />EPA/Other <br />1. Additional Descriptions for Materials Listed Above _ - <br />K. Handling Godes lar Was es Listed Above - <br />OILY WATER <br />a. 01 16. <br />C. <br />15. Special Handling Instructions and Additional Information <br />GLOVES <br />EMERGENCY PHONE 203-667.8857 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contenb of this consignment are fully and occurandr, described above by proper ship ing name and are classified, packed, <br />marked, and labeled, and ora in all respect, in proper condition for transport 6� highway according to applicable international and notion gavornmenl regulations. <br />I <br />If I am a large quontiy generator, I certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I lave determined to be economically <br />practicable and that I hhave selected the practicable method of treatment, slornpe; or disposal ...randy available to <br />me which minimize, the present and future threat to human hagfth <br />and the environment; OR, if 1 am a smaquantity generator, I have made a 9sod faith effort to minimize my waste <br />generation and select the be: waste management method that is <br />available to me and that con afford. <br />Printed/Typed Name Ny ion -.A -6Q 6 r <br />J (oFir,�4 .lure ( ert-r' <br />f <br />n <br />el)e_Yo'D 2- Months Day, Year <br />F1� <br />- I 11 4l 1 924' <br />17. Trans arta. 1 cknowled amen of Racei of Malaria s <br />y �I jj�I c; loll <br />pocb,2 �-w �-P' <br />Pr' ted/Typed <br />arae <br />$ignolum <br />Month Da Year <br />y <br />i <br />Ke <br />� 113C4 <br />r I <br />jlslaj-� <br />I <br />ro s orter 2 A.1moveNtiorment.4 Receipt of Materials <br />PriN,d/Typed Name ISignature <br />_ <br />lonth -Day Year <br />19. Discreponcy Indication Space <br />-- <br />0. Facility Owner or O orator Certification of receipt of hazardous materials <br />coversi by this manifest ezceot a, noted in <br />tiara 19. <br />rimed/Typed Noma <br />Signature <br />Month Day Year <br />DO NOT WRITE BELOW THII <br />A 1/99) <br />22 <br />22 <br />