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0 0 <br /> Please 610r type,(Form des:gnedror use cn elile(18pilch)Iypewritec) FcrmA avad.Oht6 No.Z05U-0039 <br /> 018FORF3HA2AR000S t.Ganeaatorl0Num6er 2.pa etot 1 e r R mr <br /> 9 rg!ry espouse PF.cr:e 4.NanifeslTraaking NUmUe! <br /> WAST..MANIFEST CAL000827878 1 800-732-4645 002571998 G B F <br /> 5,GraaakfsNameaml MalingAbiross GerWWS Site Address(d�fferenl Nan mat[igaddresa) <br /> AMERICAN VALLEY WASTE O1L,INC, <br /> P.O. BOX 340 <br /> Genarolars Phme:800.732-4645 DELH),CA 95315 <br /> 6.iransparlu 1Cemparry Name U.S-EPA IDI kr <br /> AMERICAN VALLEY WASTE OIL,INC, CAL000827878 <br /> 7.Transppiet 2 Companyµoma US EPA IDµeaM1er <br /> &,posynaled Paa�,ty NaoeendStaAddress DK-DIXON U.S.EPAID NDater <br /> 7300 CHEVRON WAY CAT080012602 <br /> DIXON,CA 85620 <br /> Fa spho , 707.693-6003 <br /> 9a. 94 U.S.00TOesaip6aifweu➢ng Proper Shipping Nave,Hazard Coal.ID p,m W', 16.COMalncrs 11.To1a1 1T.Und <br /> eMParkieg Grcup(dao-f) 13.L'lasteCodes <br /> Ha Typo Ouar,o'y wtw <br /> rr t' NON-RCRA HAZARDOUS WASTE LIQUID 001 TT G 227 <br /> eor <br /> (USED OIL,MIXED OIL) <br /> Z 2 d <br /> 3. <br /> 4. <br /> 14,S2epa1 Ha S InsEWOOsaMAddAknel Infama(an <br /> GLOVES <br /> PROFILE#OK080001 EMERGENCYCO1dtACT-STEVE HUBER <br /> z <br /> 15. OMERATOW&WfEROR'S CERTIFICATIM l hereby dadem Nat the cenie9sNGy ande=(A3y descrMabcmabythe proper shtppng name,ardamtlasstAed,packaged, f <br /> EVW'e-1mr6y"the Om <br /> andahlS wrreopenslnpropercmdiCtmsorereFdachedEAAckapica51e 4tle ofCn:crrid nafiavlgaemmmWregDlatlms.Ifesport A Pmenl and l am the F4wry ) <br /> Espa!er,I ar6y"the dmfen0 d Ihts mrtegnmeslardmn Id W leans of Iheadached FPAACkraawledgr:reNotCensem. <br /> I caniTYlhal ft vasle 4*NrrIQaeen slalemenl lden'ifiidIn 40 CFR M27(a)If tan a large qua n4gey eater)or(D)(01 am a small quaeliygmeralor)islnre. <br /> Gem alorsmnaWa P.wodg)pm Name 40"Ne - Monlh buy 'feet 11 <br /> ..e t faiema6ona15hipnauas ! <br /> Dim b05, 0epenlraeU.S Pat oTeMy!e16C 1 <br /> Transposer slgnehae Ito expem allyl: pzle leaving U,S.: 1t' <br /> 17.Trarn:pxyrpakr�rtatRKeiptolNatena[s <br /> TwnSpamr l Pifinedyfypad Name 1i2m%jre Month Day Year I <br /> t <br /> m polor2PnnSd/Typed Name agnaww "'Imth Day ear <br /> I. <br /> 18,�vsePaney . <br /> lea.Discrepaxy Indwon Space <br /> ❑Dvamay ❑Type ❑Resduo ❑PerLtal Roelrn ❑FuORejecdan <br /> i <br /> I,V rvfes!Retertnce NumMr. <br /> 18b.AMmale Paa!iy(a Geroialm) Lt.S.EN11p.yumter <br /> V <br /> Fadlivs Ph=: 1 <br /> loc.Sig.7aive OlAhemala Fad ity(o Gareala) Month Dry Year <br /> 2 <br /> 19.Hazar- W Ste e, nl Method Codes(Le.codes faAamfegus waste Uwa mn4disposal,endrtcyding systans} <br /> 3. d, i <br /> TO.Ceapxlod Cwnorof axon CeNraliov Cofrece M1ale�doesmelerirAs mverea hyrhe meruNest exnpl sand �e .fie .- ,JGa/T� <br /> EPA Form 870042(Rev.3-05) Previous adAbnsam obsolete. <br /> DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />