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Stale of California—Envrrondtent.1 Protection Agency �. <br /> Form Apprwld OMB No.2050-00391Expires 9-30-99] See IflstrUC}lons'on back Ct nage 6. Deparhnent of Toxic Substances Control <br /> Please print or type. Form rresignedfor use on elite(12-pit »writer. Id Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generators US EPA ID No. Manifest Document 7o�. 2. Page 1 Information in the shaded areas <br /> f: 71 %-'e <br /> .1 of required by Federal law. <br /> WASTE MANIFEST ® <br /> J. Generator's Name and Mailing Address w fK Slate Manifest Document Number <br /> goSIC,✓7'ffAL -j2«sI' 44AIe C,-�f s,7�—'ck e1v 20958683 <br /> p s� u 5cU ;N A4 ,ArCP�,J s1 <br /> y B. State Generator's ID <br /> �P N f �' its <br /> h A. neiarof`/s ne <br /> n <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Tmnsporter's ID Reserved.] <br /> h <br /> w <br /> 6 MERiCAN VALLEY WASTE OIL 2 171 7 H 0. Transporters PhormaDO,732-4845 . <br /> o] 7. Transporter 2 Company Name S. US EPA ID Number E. Sole Transporler's ID[Reserved.] <br /> 00� <br /> ysJ Q F. Transporter's Phone <br /> V alt e n to A dre s 10. US EPA ID Number G. State Faciliy's ID <br /> a b0§fViX*'9e?%1 o�L CO,iNC a o 9 19 4 & 2 7 8 <br /> LO <br /> O1700S. . TQ sQ'r H. Faciliy'$Phan. <br /> C LL ,CA 90023 8 &62-698-6577 <br /> C <br /> Q 11. US Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Canroiners 13. Total 14. Unit <br /> V No. T e Ouanli Wt/Vol I. Waste Number <br /> NOICRA HAZARDOIJ8 WASTE:UQAAD Btore 221 <br /> 3 G ;OILY WATER) 0 0 1 T T ' (j EPArOtlmr <br /> o 91 <br /> N go]b. Store <br /> ao E <br /> R EPA/Other <br /> e AStatec T C. s <br /> m O <br /> R EPA/Other <br /> � d. Stare <br /> Z <br /> w <br /> V EPA/Other <br /> w <br /> Z n <br /> J. Additional Oaiptians for Materials Listed Above - > K. Handling Codes for Wastes Listed As. <br /> o CMY WATER 01 b. <br /> h <br /> w <br /> Z <br /> Z 15. Special Handling Instructions and Additional Information <br /> ZGLOVES <br /> Z <br /> Us EMERGENCY PHONE 209-967-8867 <br /> x <br /> —r 16. GENERATOR'S CERTIFICATION: I hereby declare that thecontents of this consignment amfullyandaccurale)y described above by proper ship ping......d aredo.sified,packed, <br /> U marked,and labeled,and are in all respects in proper condition for transport by highway according to appli <br /> cable international and national government regulations. <br /> praJ If am a large that Iiry vene selected <br /> I certify that I have a d- tie in plweda re,o r the volume and toxicila of waste generated ro the degree have determined ro be economically <br /> m .ad the en and that I have selected the ll quantity method r, treatment,e.go,or disposal currently available ro me which minimizes the present and(inure geniehreat M human health <br /> and the environmentt at I if I am a small quantity generator,I hove mode a good faith effort ro minimize my waste generation and select the bast waste management method that is <br /> O available ro me and that I can afford. <br /> y Printed y Name ignature —' Month Dag Year <br /> Z I !7 <br /> w T 17. Transport r 1 5M.,ledgement of Receipt ffMaterials <br /> ww A Prirmcl/Typed Name (/ Signature (}� Month Day Year <br /> JA <br /> LL 0 TTT rans orrer kn <br /> 2 Acowled emanl of Receiptof Materials ' <br /> O T R Printed/Typed Nome Signawa Month Day Year <br /> Us E <br /> N R <br /> Q <br /> V19. Discrepancy Space <br /> F <br /> - p <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Opensuar Certification of receipt of hazardous materials covered by this manifest. t as noted in Item 19. <br /> T Prinbd/Typed Name Signature - Mor4h Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />