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Prose <br />rte <br />print <br />or olm ,. signed Por use on elate (I Z-pltchl <br />r/lo w rs" <br />1. Generotor'a US FPA ID No Mam6af Document No (: <br />2. Page 11 <br />information in th shaded arom <br />not required by Federal law. <br />F_Trpnsp. Wi, Phana <br />RM HAZARDOUS <br />o l . <br />1 <br />G. •Slits FadiNy ID <br />a 0 1 g 0 1 g <br />STE MANIFEST <br />S l <br />°f <br />Z <br />" <br />5?00 CLAUS ROADhU <br />s Nama and Mailing Address ( ) <br />f�L <br />EG.n*1.W'1 <br />A. Stale Manifest Document Number 22968251 <br />� A i� H Z V I <br />LL v <br />RIVERBANK, CA 9 +367 A L 0 0 0 1 0 `b 8 1 8 <br />4 -V209 -M-8161 <br />20n04 <br />ON <br />12, C.rwinen <br />Phone 4, S^ B to <br />B. Smte Genemmr's ID <br />h <br />N <br />No. <br />A. <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. Slate Tro ,porter'. ID jRes.rved j ,. <br />o <br />NON•RCRA HAZAADOUS WASTE: LIQUID <br />AMERICAN VALLEY WASTE OIL ALD 0 O S 2 7 87 <br />D. ironsporter's Phone , i�kU'79 J1164 <br />co7. <br />T 2 Co. a Nama 8. US EPA ID Number <br />E. State Transporter', ID [Ri,,c1cd.1 <br />J ^ <br />romp. r Pay <br />F_Trpnsp. Wi, Phana <br />�i V <br />10. <br />g,ipeLgnphd F JWA 9Te R d,5 h Add usR 10. US EPA ID Nuigber <br />G. •Slits FadiNy ID <br />a 0 1 g 0 1 g <br />facility', Phone <br />Z <br />5?00 CLAUS ROADhU <br />)1 0 <br />RIVERBANK, CA 9 +367 A L 0 0 0 1 0 `b 8 1 8 <br />4 -V209 -M-8161 <br />,) <br />V LL <br />v V <br />11, US DOT Description linA(ding Proper Shipping Name, Hazard Class, and ID Number) • - <br />12, C.rwinen <br />13. Total <br />Ovantity <br />id. Unit <br />Wt/V.I <br />1. Wash Number <br />No. <br />Type <br />Z <br />NON•RCRA HAZAADOUS WASTE: LIQUID <br />Stan, - 221 <br />3 <br />( OILYWATER) <br />0 0 1 <br />T T <br />G <br />EPA/01h., <br />G <br />. <br />o <br />E <br />b <br />Sian _. <br />Cs <br />N <br />o. <br />E <br />a <br />R <br />`A <br />- <br />v <br />- <br />Sale _ <br />o <br />0 <br />0 <br />a <br />( <br />EPA/Othery� <br />. <br />. <br />EPA/01h., <br />U <br />W <br />J. Addiddnal Dekrlpliom for Materials luted Abo,e <br />K Handling Code, for Wailes <br />listed Above <br />0 <br />OILY W14TER <br />k S RPS i� ate • <br />6 s r <br />it <br />15. Special Handling Instructions and Additional Information- T <br />ie f ►-{2 E. �-R'o looQ <br />Q <br />GLOVES n 1 <br />EMERCENCY PHONE 209-667-8857 <br />Q16. <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consiQnmant are fully and accurately described phare by proper ship Ing name and aro classified, pocked, <br />labeled, for highway <br />V <br />marked, and and are in all respects in Proper condition transport Ey according to applicable innhmaiidrrwl and nation°Pgovernmenl regulations. <br />J <br />a_ <br />If I am o large quontiry generator, I certify that I haw a pro ram in plan to reduce the volume and toxicity, of wash generated to the degree I hwa determined to be wonomicallYY <br />that I how the disposal the hours throes to human healz <br />practicobie and selected racticable method of treatment, sforoge, or currently available as me which minimizes present and <br />and the am,inonmant; OR, if I am a small quantity generator, I have mode a good faith effort to minimize my waste generation and select the bait wash management method that i, <br />s <br />OOff <br />available to me and that I can afford. - <br />y <br />Prinh nine - <br />Signa N <br />Mon Y <br />W <br />T <br />17. rons rear 1 Acknowled arrant of Rwei t of Malarial, <br />w <br />F <br />0. <br />0. <br />" <br />Prin T Name <br />Si naan - <br />Month ay Yea <br />W <br />z16 <br />P <br />o <br />W <br />B <br />I8. Trans her 2 Acknowled amens of ecei t o Materials - <br />TPrinted/Typed <br />Name <br />Signature -^?" <br />Month Day Year <br />W <br />Q <br />E <br />R <br />I <br />U <br />19. Discrepancy Indication Space <br />_ <br />A <br />C <br />i <br />L <br />1 20. Facility Owner or Opiinofis, Certification of recei t of hazardous materials covered by this manifest e.ce t as noted in Item 19. <br />T Prinhd/Typed No. Signoturo Mon Day Year <br />4277 �tiK CTS 0 G /10 S <br />I IL <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 Green: TRANSPORTER RETAINS <br />