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Stab of California—Environmental Protection Agency _ 1 <br /> ,form Appr&ed OMB No.2050-0039(Expires 9-30-991 See Instructions OD back OI -9e 6. Deportment of Toxic Substances Control vl <br /> Please printer type. Form designed for use on&lib(12-pikh, •ribr. Socrom ado,California <br /> u <br /> UNIFORM HAZARDOUS I. enembr's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br /> . s <br /> WASTE MANIFEST C A C O D 1 4 7 6 5 2 8 914 6 5 aft is not required by Federal law.� ;7 <br /> 3. Generator's Nome and Mailing Address Docs Atkumbar- .y ! <br /> LA FNCA NO. 7 PARTNERSHIP 9 l <br /> $ P.O. BOX 1307, GRASS VALLEY, CA 95845 B. Slate Gore rat.6ID <br /> W) <br /> A. Generator's Phone 1530 1418-6464 <br /> N 5. Transporter I Company Name 6. US EPA ID Number C, State Tronsportcr's ID(R a.l <br /> h <br /> w <br /> p ,D. Tra spoiler's Phone ' <br /> O t4M CAI 00 1r1A1D1q IR 17141-11712 _i <br /> act <br /> 7. Transporter 2 Company Name 8. US EPA ID Number State Transpodar's ID( eserved.) <br /> OQ , Transports.-s Phooe <br /> hn tJ 9. Desi noted FacilityName and Site Address 10. US EPA ID Number G State Fac lily's ID 1' <br /> g AMERRICLEN, INC. ) <br /> 2570 ALMOND DR. <br /> �W <br /> W SILVER SPRINGS, NV 88429 INIVID19181213151814 8 3 <br /> M Q 12. Containers 13, Total 4. Unit <br /> 7)V 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) No. T Quantity WI/Vol 'h'Waste Nnm6ei- <br /> T 9 ANON RCRA HAZARDOUS WASTE LIQUID 5iO1e 22 <br /> 3 G (OIL &WATER) EPA/oche <br /> E <br /> o N b. <br /> 00 E <br /> v R LL <br /> y <br /> a A <br /> 6T ° � <br /> o i <br /> R <br /> 1 <br /> F d. t <br /> .Z <br /> U <br /> Z TANKi3TTOMYYASTE „ r <br /> W <br /> ss d <br /> a � <br /> 0 15. Special Handling Inkuclions and Additional Information '! <br /> a APPROPRIATE PROTECTIVE CLOTHING JOB SITE: 97 <br /> W `EMERGENCY CONTACT: (209)652-8900" 1611 S. AIRPORT WAY <br /> SEE E.R.G 171 STOCKTON, CA 95206 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment or.fully and accurate)r described above by proper shipping name and ore classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according b applicable international and national government regulations. <br /> -mss If I am a large quantity generator, certify that I have a progrom in place b reduce the volume and toxicity of waste generated to the degree I have determined to be«onomicollyy <br /> a proctica6le and that I have selected the practicable method of Irenhnent,storage,or disposal currently available to me which minimizes t e present and future threat to human h.1% <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my wash enerotion and select the best waste management method that is <br /> ac available to me and that I can afford. t <br /> OPrins /Ty Nams ^ e SignaNn Month Day wr <br /> U ' /V / <br /> Z <br /> W T 17. irons iter I Acknowledgement of Receipt oterich, <br /> ,a A Prinbd/Typed Name Signature Month Day wr <br /> 1 <br /> W f <br /> ss. 1 18. Turns iter 2 Ackn°wled ement of ecei 1 of Mabriali <br /> O T Printed/Typed Nams net a Month Dvy Year <br /> W E <br /> N R <br /> V19. Discrepancy Indication Space "•"� <br /> 9 A <br /> C <br /> L <br /> Z0. Facili Ownor or Operator Codification of recei 1 of hazardous materials coverd by this manifest ex<a of as noted in It..19. <br /> T Prmhsd/Typed Name Signature Monts Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN . <br /> DTSC 8022A(1/99) To: P.O. Box 400, Socra>ne b, CA 95812-0400 <br /> EPA 8700-22 <br />