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Please t a type. (Form designed for use on elite (12 -pitch) typewriter.) <br />TRANSPORTER'S COPY <br />'UNIFORM HAZARDOUS It (ienamkx ID Number rrnrn rypmve0, vMtl N0.2050-0039 <br />2'Page'of 3. Emergency Response Pfgne 4. Manifest Trackkiing Number <br />WASTE MANIFEST C A 1„ 0 0 0 g � 7 $ T 8 <br />S. Gene2:ofs Name and McNitg Address 2t7�_".r 667 j <br />2581 FLE <br />V <br />AVERK-AN VALLEY WA6I F OIL INC Generators SiteAdtlreas i drivru(n than mailing address) <br />P 801.. 240 <br />Generators Phone. '`Ili CA 95.315 lou-t`i15/-�Ig&7 <br />itdrsporter i ampany Hama <br />>'"'CAN VALLEY WASTE Lift. US. EPA ID Number <br />7 Trarspenar 2 Company Name CRL0 %0l 27870 <br />- U.S. EPA{D Nwnber <br />9. Designa[atl Fapety Name and SlEv A; In <br />U.S. EPA ID Number <br />UK-OxOa <br />7;,A�D CHEVRON WRY <br />Faye fio- cit 6dBri{l ;7u7rr{i ti-{ytstt cnTo6opaah0; <br />sP ne <br />ga <br />go. U.S. DOT De=ipton 0101ding proper Shipping Name, Hazard Class, ID Number, <br />Hai <br />and Packing Group (if any)) <br />10. Cpnlainers <br />11. Total <br />11. Unit <br />No. <br />Type <br />1 - <br />DONNY <br />Wt.rva. <br />13. Waste Codes <br />o <br />WON FtCRA NALAk{YE>L18 WAS7F l,lQi/iD <br />--- <br />— <br />{ t7rLE[) ctj M/tf:12 OIL <br />0 b 9 <br />7 7 <br />z <br />z. <br />w <br />ca <br />3. <br />4. <br />th. Special Hantllkg nsbuNors and Additional kdotmatwn <br />011-{}1[57 <br />PROFILE it LA0151OW-1 <br />TNUC.K 9 r' t <br />15. QENERATOR'S/OFFEROR'8 CE FIGA ON: I hera0y dedere that the contents of tltis consignment are tufty and accuratrrey described above by mo proper shipping name, and sre classified, packaged. <br />marma and IabeieNplacinded, and are in as respects in wMiuon for <br />proper transport according to apphcable interna" and national govemncentel regulations. tf e <br />Exporter I cerW Nat th contents of this consignment confonm to the ddre <br />dmfs of the altad EPAAcknowledgmenl of Consent xpori shipment and am Ne Primary <br />I owy that do waste mirdntizelion statement iderib in 40 CFR 262.27(a) (H l am a large quantity gsneredr) or (b) (d I nall quww gentridgws bue. <br />Ganeralorslofferi <br />PnnWyped Ngna ure <br />Y year <br />18JntemedonaBhpments *'i+F/�""' <br />_+ <br />i <br />- EJ❑ <br />Import to U.S. Expert from U.S. Pon <br />of antry/04 <br />Trac er re for s only) -- <br />W <br />Data ledong US.: <br />17. TrampdmerAckroMadgment of Receipt of Materials <br />O <br />rawponer 1 Pmned+fYped <br />lin N <br />G <br />Transpeder 2 Pm1ed/Typed4Jam <br />¢ <br />g� We <br />e <br />v17 <br />♦ <br />19, Discrepancy <br />t8a DisaeFsUoY bdicalion Spa,,, <br />O'wndy, �TWa ❑Residue <br />Penial RajecMn ❑Fell Rele:Con. <br />18bA'tamale <br />Faality lar Gcmeaux) Manifest Reference Number. <br />U.S. EPA ID Number <br />U <br />Q <br />LL Fac9rt <br />w '&. <br />sFhone: <br />Signelure of Nlemate adgry (or Generales) <br />- MohN De; 'fear <br />13. <br />w <br />Hazardous Wastes Ra Me <br />Wn nagament McNgtl Codesji e., modes nor hazardous waste Ireatmem, disposal, and recyding systems) <br />1 20. <br />Desig mlw FaciliWry Owner or Odaralor. CerU5mlron of recont of hazardous maleiiels covered by Ns marafest except as noted'n tlem 19e <br />Pdn'.a;Uiyped <br />Name a 3lgnaaue <br />nth oy Year <br />EPA Fonn <br />8700-22 (Rev. 3-051 Ffmvlous editions are obsolete.•�� <br />TRANSPORTER'S COPY <br />