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StA of Cali Farria—Environmental Protection A ncy t <br /> 'Form Approved C?hrAB No,2050-0039(Expires 9 0.99( �" _ ;,,,See Instructions on back 'of pry Et5 Department of Toxic Substances Control <br /> Please print or type. Form designed For use an elite(12-pitch) er. � z Sacramento,California <br /> 1. Generotor's USEPA�ID—No. Manife ouumenl No. 2Pae I lfliifhe.shaded areasUNIFORM HAZARDOUSf r� at is not required by Federal few. , <br /> WASTE MANIFEST j �) <br /> 3. Generator's Name and Mailing Address menen I EA Stale lNtantfestfcumenf Number r <br /> -73-73 wesr L.^�� 11 58",7 <br /> o B S�atq , <br /> h 4. Generator's Phon _ �� �t 4.Gene �� V •F �Ul�.r �T f, "; r v <br /> 1 jY <br /> �147�0 313 Ca .9,5340 <br /> N 5. Transporter 1 Company Nome .- 6. US EPA ID Number C��Sp Tis6}pat}q [) R served] :, <br /> C? <br /> AMERICAN VALLEY WASTE OIL A L 0'0 0 8 - 2 7 $ 7 $ aleft ,tiCner. <br /> m 7. Truns orter 2 Com an Name - "T'T'� s�tle }• <br /> P p Y 8. US EPA 1D Number E r5Ote {an 1D Resetosd ' <br /> + <br /> DQ F TfP(1SFS0►Iljt6 S :'A <br /> (�U RIV MW0*.eTRAff8fER 10. US EPA ID Number G Stayer 1 4� �ny 04 <br /> Z 6300 CLAUS RDA© <br /> ;0 <br /> 0 RIVERBANK, CA 95367 C A L 0 0 0 1 9 0 8 1 <br /> t-- <br /> —4 12. Containers 73 • 14 Unit '� •• <br /> 1 i. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) . Tot.] - <br /> V No, Type Quantity Wt/Vol 1. Waste Number. <br /> z NON-RCRA HAZARDOUS WASTE LIQUID -state <br /> (OILY WATER) 00 1 T T b G <br /> 3 G EPA/Other <br /> o N b. <br /> State <br /> 00 <br /> aE <br /> EPA/Other, <br /> v A <br /> a. <br /> p - T00 <br /> - $safe r x '• <br /> It EPA/Otha"A: <br /> H d' State <br /> Z <br /> EPA/Other <br /> LU <br /> zJ. Additional Descriptions for Maierials Listed Above K.•'Hondl"sng Cedos for.Wostes Listed Above <br /> o OILY WATER'. a a1 t b. r <br /> r <br /> O15- Special•Handling Instructions and Additional information <br /> Q GLOVES <br /> Z EMERGENCY PHONE 20$ 67-8857LLJ <br /> i <br /> t- <br /> 16. GENERATOR'S CERTIFICATION: i hereby declare that the contents of this censi nment are fully and accurately described above fay proper shipping name and are ciassified,packed, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantity generator,I certify that I have a pro ram in plots to reduce the volume and toxicity of waste generated to the degree I have determined to be economicallyy <br /> 0' practicable and that i have selected the practicable method <br /> Tare <br /> storage,or disposal currently available to me which minimizes the present and future threat to human heath <br /> and the environment;OR,if I am a small quantity generator, i have made a good faith a#or to "mize my waste generation and select the best waste management method that is <br /> 0 available to me and that I can afford. <br /> Printed/Typed Noma+' Signature ` nth Doy� ar <br /> Z T fv'"_ tJ <br /> ((D R 17. Transporter i Acknowledgement of Receipt o Materials <br /> Ce p Printecl ed Name 5'r n❑ <br /> $ °� Mon>k ZDay Year <br /> a,ss P <br /> R, 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> p R <br /> LU T Printed/Typed Name Signature Month Day Year <br /> U) <br /> f <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> � F <br /> A <br /> C <br /> I <br /> L <br /> f 20. FacilityOwner or Operator Certification of receipt of hazardous moterials covered b this manifest exce t as noted in Item 19, <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99( Blue. GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 6700-22 To P.O, Box 400, Sacramento, CA 95812.0400 <br />