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Stole of C.N.rai.—Environment.]Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9 30-991 See Instructions on back c 19e b. Department of Toxic Substances Contrc <br /> 1 Pleas•prim or type. Form designed foryse on.tfd f f2-pikh�.Wwribr. vet Sacramento,California <br /> UNIFORM HAZARDOUS I. Generolor's US EPA ID No: Manifest D.Cxnent No. 2. Page I Information in the shaded ares <br /> I <br /> WASTE MANIFEST Lr' I U In v of is not required by f.deral low. <br /> 'I 3. Generators Name and Mailing Address I e O Pi <br /> f E TI A. Starts Manifest Document Number ^^7 O O O^ O <br /> q1)q N. 6rueno <br /> 8 <br /> P�- LL I Vh <br /> . Slate Generator.ID <br /> h d. Ge^x.t.r s PMne 16,3.3%-/.3 1�Q1 M O CA 95,2W I I I I I I I I I I I <br /> N 5. Transpxler 1 C9mpony Name 6. 5 EPA ID Nulnb•r C. Stale Transporter,ID[Reserved.] <br /> h <br /> i $ AMERICAN VALLEY WASTE OIL A L. 0 0 0 1112, 7 7 8 D. Transporter's Phone 801.1-?J2-4645 <br /> O�. 7. Transporter 2 Company Name 8. US EPA to Number E. Slab Trampoctd,ID IRes .] <br /> `O F. Transporters Phone <br /> IC)� Tt�E/«GWhF�'E1�10' E^d^I�$IIME It l0. US EPA 1D Number G. Slaldforky CIDQ 0 0 t E9 (� B 1 6 <br /> IC) a 5500 CLAUS ROAD I I I I I I I I I I I I <br /> 11� H. Facility'.Ph", <br /> C� O ItIVEHOANK, CA 9516? A L 0 0 0 1 0 0 1 G 209-00"101 <br /> I�L Q12. Containers 13. Total id. Unit <br /> V 11. US DOT Description(including Proper Shipping Name,III Class,and ID Number) No. Typ. Quantity Wt/Vol I. Waste Number <br /> k Z o. NON RCRA HAZARDOUS WASTE LIQUID $°te 221 <br /> 3 G !OILY WATER ) 0 0 1 1 T / r 4 EPA/Other <br /> CE b. s Stole <br /> as E <br /> EPA/Oh., <br /> I A -� - <br /> o T c State <br /> m R EPA/Other <br /> W d. Slab <br /> Z <br /> Z <br /> W EPA/Other <br /> W <br /> W <br /> ' 0 J. Additional Descriptions for Materials Listed Ab... _ K. Handling Codes{ar'Watlas Wbd Above , <br /> Z �DILY WATER a. 01 b' <br /> P <br /> W — <br /> I ac 1 C. d. <br /> J <br /> 1 <br /> 9 15. Special llaadlinq Instructions and Additional Information <br /> a GIOVFS <br /> Z EMERGENCY PHONE 20-11-1307.8857 <br /> I W <br /> H _ <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that thec.Ilml,of this c.nsig meal or•fully and xcurablY described abvly try propenhip Ing name and are classified,packed, <br /> UQ marked,and labdd,and are in all respects in proper condition for transport by highway according to applicable internatk^cl and notion government regulations. . <br /> J <br /> II I aic a larg ghat III <br /> generator,selected <br /> 1 certify tic]I have a d a treatment, <br /> in plan la reduce is mil cu and to..il.of wwb gensrcbd al the degna have determined to to ecman hesIX <br /> n precti<able and that I hhaw wlxled die practicable method o Iraamant,Horaga,or disposal currently ovailabb I.ma which minimum du rasenl and furore Ihraol to human health <br /> 1 and 1M mrironmenl;OR,if I am a small quonlity generator,I have mode o good f lith effort to minimize my waste genarc lien an •et the best waste management method that is <br /> available b me and that I can afford. _ <br /> OPr' bd/Typ.� am• Signature I. Month Day' Ywr <br /> 19 <br /> W T V. Tram rix 1 Acknowledgement of Receipt of Material, C. <br /> Month � Day Y. <br /> W $ <br /> a. 1 18. T,..tporlr2Ackaowl•d amen r f Rxai 1 of Materials <br /> O E Prinbd/Typed Name $ignatun Month Day Year <br /> II141,E E <br /> R <br /> V19. Discrepancy Indication Space <br /> Iz A <br /> C <br /> I <br /> L <br /> t l .20. facili Owner or Onsrator Certification of receipt of hoz.^docs materials<ovred Ihis manifest except a,noted in Item 19. <br /> T Prinbd/Typed Name Signaler• - � Month Day year <br /> Y I I I I I [— <br /> DO NOT WRITE BELOW THIS LINE. <br /> ` DTSC 8022A ll/99] Yellow. GENERATOR RETAINS <br /> EPA 8700-22 <br />