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utote ofColitornio—EnvironmentalProtection Agency <br /> Form Appr0ed OMB No.2050-0039(Expires 9-30-99) See Instructions on back of nage 6. Deportment of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch) vriter. <br /> Sacramento,California <br /> -----UNIFORM HAZARDOUS en.rolor s US EPA ID No. Manifest Documen1+73"w 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST �. _ is not required by Federal law. <br /> L ) d <br /> of <br /> 3. Generator',Name and Mailing Address A. State Manifest Document Number <br /> � ( t� 24715047 <br /> B. State Generator's ID <br /> A. ass,erabit's Phone( ) fF !'s <br /> N 5. Transporter 1 Company Name US A 1 Number <br /> h C State Transporter's ID[RexervedJ <br /> W <br /> $ sM!=f'ICAN VALLEY 4YN1'E'!)fL { t. ( D. Transp.H.r's Phone <br /> °D 7. Transporter 2-Company Nama <br /> P P Y 8. US EPA ID Number E. State Transporler's ID[Reserved] <br /> VF. Transporfer's Phone <br /> CP <br /> 10. US EPA ID Number G. State F� ili(y's 1D <br /> u J— ;;dM CLAUS HOAP,7 <br /> RIVERBANK- CAM5,W7 � 9 H. F litrsPhon'3cYi t'9 k.°h <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total IA, Unit <br /> 0. No. T e Ouanny Wt/Val I. Waste Number <br /> NUN-RCRA H"-ARuous WAsn LIQUID Stat. <br /> 221 <br /> G f O11 Y'WATT-R i r) C1 EPA/Other <br /> o N b. C. Y <br /> C0 E Slat. <br /> R EPA/Other <br /> O T <br /> 00 O State <br /> R EPA/Other <br /> of <br /> d. <br /> Z State <br /> W <br /> U EPA/Other <br /> w <br /> Z 1. Additional Descriptions tar Materials Listed Above K. Handling Codes far Wastes Lilted Above <br /> Z <br /> v91..S"tr`vA�,e3cfY. a:S.? 6. <br /> as <br /> OL <br /> d <br /> Z <br /> Z <br /> O 15. Special Handling IrWuo.r,and Additional Information <br /> Z GLQVL6 <br /> _ <br /> EMERGENCY PHONE 21-7 D-t3ti7!?�fi! <br /> t- <br /> V=t 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and acc.ratelr described abovebyproper shipping name and are classified,packed, <br /> marked,and labeled,and ore in all respects in proper condition for transport ley highway according toapplicable international and nation.Pgovernme°t regulalions. <br /> IF I am is large quanliy generator,I certify that I have a program in place ro reduce the volume and toxicity g gree I have determined to be economical) <br /> d h I ly l tome which <br /> min ro the de YY <br /> w pmdicabls and that ave selected the practicable method o treatment,storage,or disposal cmrondy available ro me which minimizes Ata present and folate threat ro human heal <br /> P the environment;OR,if I am a small quantity generator,I haw made a good faith effort to minimize my waste generation and select the best waste mono <br /> gomanl method that is <br /> O vailable some and that I can afford. <br /> y Print <br /> Qd/Typed Name Signature Month Year <br /> Do <br /> fee <br /> W 7 17. Transporter I Acknowledgement of Receipt of Materials <br /> U It <br /> W A Printed/Typed Name Signalu <br /> � S Month Day Year <br /> W R / / <br /> Lt. R I Trans Her2Acknowled .mento eaei toF Materials r l - ' <br /> O T Printed/Typed Nome Signature <br /> W E Month Day Year <br /> U A <br /> U E 19. Discrepancy indication Space <br /> Z <br /> _ q -o <br /> C <br /> ( <br /> L <br /> 20. Focili Owner or Operator CoaiFication of recei 1 of hazardous materials covered b this manifest exce i as noted in tem 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A(1/99) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />