Laserfiche WebLink
Stw of Callforola—Enviro oner8al Protectbn Agency <br /> See Instructions on back� Sacramento, <br /> to age 6. DepartmTaSubstances comm <br /> Form Approved OMB No.2050-0039(Expire.9-30.96) �� crara mento,California <br /> Please print or type. Form designed for use on e8ro(12,pikh)typewriter. <br /> 1, Generator's US EPA ID No. Manifest Document No. 2. Page 1 wwr,alion in the shaded areas <br /> UNIFORM HAZARDOUS is net required by Federal law. <br /> WASTE MANIFEST CAC 0 0 1 2 3 5 2 3 2 9 1 5 Oil of 1 <br /> 3. C nmaoar's Name and Mailing Address A. Scots Manifest DacuneM Number96591501 w 5 9 1 5 0 1 <br /> STAR BUILDING SYSTEMS Vh <br /> 12101 E. Brandt Rd. , Lockeford, CA 95237 B. StaeGaneraoi.ID <br /> 4. G.ozente:.Phare 209)727-5504 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. Store Transporter's ID <br /> eco NOR CAL OIL D 9 8 2 4 1 7 2 5 5 D Transport°""1OAe (209) 667-6692 <br /> Q 7. Transporter 2 Company Name <br /> B. US EPA ID Number E. State Transporfer's ID <br /> U F. Tremspoaer's Pham <br /> Q 9. Designated Facility Name and Site Address 10, US EPA ID Number O. Stora F iltyI D <br /> W AMERICLEAN, INC. <br /> `--A 2570 Almond Dr. H. Fadlly'AYham <br /> rnQ <br /> SilverSprings. NV 89429 N V D 918121315 8 4 8 3 0�-_4 - <br /> 2105 <br /> (.n V 12. Containers 13. Total 14. Unit <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) T Quantity WI/Vol I. Waste Number <br /> NON-RCRA HAZARDOUS WASTE HAA LIQUID 0 0 1 Store 223 <br /> 3 (WATER & OIL) EPA/OMer <br /> TIT 0jq0jqj G <br /> m N b . Slam <br /> aD <br /> N R EPA/Other <br /> A State <br /> ag T <br /> O <br /> R EPA/Oter <br /> K <br /> W <br /> Z d. <br /> W <br /> U EPA/pMr <br /> W <br /> N <br /> OJ. Additional Descriptions for Materials Listed Above K. Handling Codes for Wash Used Above <br /> TANK BOTTOM WASTE b. <br /> RINSATE c. d. <br /> Z <br /> Q 15. Special Handling Instrvctions and Additional Information <br /> a APPROPRIATE PROTECTIVE CLOTHING <br /> Z "EMERGENCY CONTACT: (209) 667-669211 <br /> = SEE E.R.G. PAGE 31 <br /> r <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name marl are classified, <br /> Q packed,marked,and labeled,and ore in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <br /> 11 1 am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be <br /> economically practicable and that I have selected the practicable method of trete nenl,storage,or disposal currently available to me which minimizes the present and future <br /> Nthenar to human health and to environment;OR, R I am a small quantity generator, 1 have made a good faith effort to minimize my waste generation and select the best <br /> w waste management method that is available to me and tout I can afford. <br /> O Printed/Typed Name Richard Thorpe agent fo Signature Month Day Year <br /> 111 10 11 19 16 <br /> Z T 17. Transourner 1 Ackmowle! eLlfrltmaei ligof Materials <br /> (� h Printed/Typed N Signature Month Day Year <br /> M : G 1 11 01 11 916 <br /> aA 0 18. Turns r 2 Aeknowled m <br /> eent of Receipt of MatMonth erial <br /> 0 Prinrod/Ty Dame Si nature � ®Day Year <br /> E <br /> A <br /> yWj 19. Discrepancy Indicallon Space <br /> Q F <br /> V A <br /> Z C <br /> t <br /> I. <br /> I 20. Foci' Owner or rater Certification of receipt of hazardous mL;;ore' ver is manifest ex< 1 as rated in Ilam 19. <br /> T Pr' /Type Name Si noNtt ( Month Day r <br /> 02 <br /> DO NOT WRITE BELOW THIS UNE. <br /> whoa- ISDf SENDS THIS (OPY IO DISC WIT11IN 30 DMS, <br /> DTSC 8022A (1/95) 1, P.O. Be. 3000, Sacramento, CA 95812 <br /> EPA 07022 <br />