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States of Cdifo ni --E.Annemenld ProNcHon Agency <br /> Form Approved OMB No.2030-0039(Expires 9-3496) See Instructions on bac*age 6. Deportment of Toxic Substances Control <br /> Please print or type. Form designed for use on dib(12-p lypewriter. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST E °! <br /> m <br /> 3. GeratorL Nam and Mailing Address A. Slate Monifevt gf Number <br /> MOHAMMED MALIK <br /> 965915,10 <br /> N 6560 E. Hwy 12, Lodi , CA 95240 /11222 Cedar Creek Ct. e. side Ge andore ID <br /> I. Generators Phone ( ) Aodasto, CA 95.357 <br /> 7. Transporter 1 Company Name 6. US EPA ID Number C. $hah Tmospaders ID <br /> OP <br /> J <br /> NOR CAL OIL CAD 918121 4 1171 2 5 h D. T'°"p°"° `""°°° (260 667460 <br /> Q7. Transporter 2 Company Name 8. US EPA ID Number F. State "anepdrtars ID <br /> U <br /> M F. Transporters PhoneLo - <br /> 4 <br /> Z 9. Dadpmhd Facility Name and Site Address 10. US EPA ID Number G. Sbte Facility's l4 <br /> AMERICLEAN, INC. <br /> a 2570 Almond Dr. H. Fadi y e PL <br /> InvSilvers Springs. NV 8 420 1 N <br /> ZProper 1N2o Containers13Total Unit US DOT Deai �an including ShiPPm Name,Hazard Class,and ID Number) T e Ouanry WI/Vol <br /> I. Waste Number <br /> a. <br /> NON-RCRA HAZARDOUS WASTE LIQUID shoe223 <br /> 3 G (WATER 6 OIL) 00.11 T T L c);;1 cJ G EPA/ahe, <br /> � E _ <br /> Go N b. Slate <br /> adp E <br /> N R EPA/Other <br /> gy A <br /> T c. stole <br /> O <br /> d, R EPA/Other <br /> ZZ d. State <br /> W <br /> V <br /> EPA/Other , <br /> Z 1 K. HSmdWor Co*for Wakfa�I1,Mf�Abi5Yf4, ., <br /> 0 e <br /> rn <br /> w <br /> sY <br /> sels <br /> J <br /> Z <br /> 2 <br /> 0 1S. $pedal Handling Instructions and Additional Information <br /> 1- APPROPRIATE PROTECTIVE CLOTHING <br /> Z "EMERGENCY CONTACT: (209) 667-6692" <br /> = SEE E.R.G. PAGE 31 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping nome and are classified, <br /> Q packed,marked,and labeled,and are in all respech in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <br /> 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 I have determined to be <br /> y economically practicable and than I have selected the practicable method of treatment, storage,or disposal currently available to me which minimizes the present and future <br /> H throat to humors heakh and the environment;OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> 6' w=sle mars= meal method that Is available to me and that I can afford. <br /> O pdsaad/Typed NameRichard ThOrPe agent for Sig ra Month Day Year <br /> Mohamed aMalik r t� / <br /> Z T 17. Transporter 1 Acknowledgement of Recallat of Mahriu" <br /> (� A Printed/Typed Name Sipature _ MorIM Day Year <br /> 0 18. Turns rler 2 A of Regi of Martindale <br /> • / <br /> w T Printed/Typed Name Slgnedure Month Day Year <br /> O E <br /> R <br /> W 19. Discrepancy Indicadon Span <br /> g F <br /> A <br /> I Z 1 <br /> _ k <br /> 20.—F,111ty Owner or Opefroarr CerHfic=tion of recei t of hazardous materials covered b this manifest except as noted in Item 19. <br /> T Primed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A (1/93) Yulb.w: (ikIJLRAlok kbTAlllb <br /> EPA 8700-22 <br />