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Street of Califomlo—Endronmental Protection Agency <br /> Form Approved OMB No.2050.0039(F-PIM 9.30-96) See Instructions OD back Or '92 b. Department of Toxic Substances Ce <br /> Sacramante,Celllorfimsi nm j <br /> please print or type. Form dmigned for uu on eFM(12pf ch) wri '- <br /> rclo <br /> Gensralor's US EPA ID No. Manifest Document No. !I Page 1 Informative in rite shaded areas <br /> UNIFORM HAZARDOUS not required by Federal law. <br /> WASTE MANIFEST A C O 0 1 2 3 5 2 3 2 9 1 5 1 °'1 <br /> 3. Oewrosm's Name and Mailing Address A.State manifest Document Number <br /> STAR BUILDING SYSTEMS <br /> 12101 F. Brandt Rd. , Lockefordp CA 45237 St. State Generao's ID <br /> 4. Geremata..Phan. e09)727-5504 <br /> 5. Transporter 1 Company Name 6. US EPA to Number C. State Tronspoom's ID <br /> NOR CAL OIL D. Trapaporter'%Next <br /> 2 4 1 7 2 5 5 209 667-66922- <br /> 7. Transporter 2 Company Name ,S. US EPA ID Number E. State Transporter's ID " <br /> J U F. Transporter'% Phmx, <br /> �l a G. Stele Facility's ID <br /> 9. Designated Facility Name and She Address 10. US EPA ID Number M 1 <br /> AMERICLEANe INC. <br /> H. Facildy's Ph ora. _ a <br /> �s 2570 Almond Dr. - <br /> VSilver Sarinnt, NV 89 29 INIVID191A191-11518141313 <br /> fro 11. US DOT Description iMledin Pro r S Name,Hamed Class,and ID Number M0 Conte nen 13. Tolyl Wf £ <br /> •A Z (including Pe Shipping ) No. T Quantity Ws/Vol ;i Wash Number }•, <br /> °' NON-RCRA HAZARDOUS WASTE KIAN LIQUID store <br /> 3 a (WATER 8 OIL) 0 0 1 EPA/Other , <br /> ET T D UUq G <br /> H b. re <br /> Sta <br /> I E <br /> N R EPA/Croner <br /> 11 T <br /> T a. <br /> O <br /> R EPA/Other <br /> 12 1 z d State <br /> W <br /> U EPA/Olhet <br /> N <br /> Z — <br /> J. Additional Descriptions for Msderiah Uated Above K. Handling b---d-Above <br /> 11 W TANK BOTTOM WASTE 6, <br /> RINSATE <br /> I J <br /> Z <br /> 15. Special Handling Instructions and Additional Information <br /> l s APPROPRIATE PROTECTIVE CLOTHING <br /> z "EMERGENCY CONTACT: (209) 661-6642° <br /> W SEE E.R.A. PAGE 31 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare the the contents of this consignmo oro fully and accurately described above by proper shipping name and aro classified, <br /> a packed,marked,and labeled,and are in all respects In proper condition for transport by highway according to applicable international and nwtiowl gammmaM regulation. <br /> lJl If I 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 1 have determined to be <br /> —t ecowmically practicable and that 1 have selected the practicable method of treatment,storage,or disposal currerdly available to me which minimizes the present and future <br /> N threat W human heahh and the emiromnentt OR,if I am a small quantity generator, I have made a good fWtii effort m minimize my were generation and select the best <br /> ac waste management method that is available to me and that 1 can afford. <br /> O PdnW/Typed Name Richard Thorpe agent fn signaNro / <br /> Month Day Year <br /> 111 10 11 19 16 <br /> Z 17. Tr 1 Ac6ro - nt <br /> mea Recei of Matariab Year <br /> S Printed 7 d Name Signaturo i7 Month Day <br /> / rpe / <br /> 7 - �. <br /> ev <br /> Z <br /> 10 11 9 <br /> w018. Transporter 2 Acknowledgement of Regi of Material, <br /> k Printed/Typed Name SlgmNro month Dry Year <br /> 1 <br /> O Eft <br /> U.1 19. Discrepancy Indication Space <br /> U F <br /> A <br /> Z I <br /> I <br /> L <br /> I 20. Fact Owner or rater Certif cell.of receipt of hawrdon materials towered this manifest axc t m no <br /> ma Rem 19. <br /> T Printed/Typed Name Sigiwtero Momh Day Year <br /> IT , <br /> DO NOT WRITE BELOW THIS UNE. <br /> DISC 8022A (1/95) Yeflowm GENERATOR RETAINS <br /> EPA POD-22 <br /> _.... .___. __ ._.a__`---.—.__—.-1__.— ——_— —_._._..- �...... <br /> _..—. <br />