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% 11al Protection Agency <br />sb-OOV'[txpires 9.30-99) j See Instructions on back of page 6. <br />designed foP use on elite f f 2•pilch) fypewrilor. <br />Department of Toxic Substances Control <br />Sacramento, California <br />/QRM HAZARDOUS <br />WASTE MANIFEST <br />. Generator's US EPA IC No. Manifest Document No. <br />2-10013 15..all <br />�-.Aibnof?Ail <br />2. Poge I <br />Information in the shaded areas <br />u not required by Federal law. <br />Araior's Noma and Mailing Address <br />�G_C�II�*���['�y.�"�.�YI Y��s,+,�h��9 <br />1)0 s t Il 1f�.� ry�1/1�' <br />4. Generator's Phone [ .)`b Kt <br />A. Stale Manifest Document Number <br />��.�.42T�4? ' <br />fiStole Generator's ID - • <br />5, Transporter 1 Cornpany ohne b. US EPA ID Number <br />'t.M #i:_itICAN VALLEY WASTE OIL � 7 s' ! a 7 8 <br />G, Slafe.Trantporler's ID IReservedl <br />D. Transporter's Phoneb0 0-Z:°1��� <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID [Reserved.) <br />F. Transporter's Phone <br />)at�d�Fggiky 1`l o and Site Address 10. US EPA ID Number <br />'' •i .a -t ;" LMOND OR • <br />:.iL_ V! WPRINGy,, , NV 84 429 y P.l9 2 P P 18 14 IS 13 <br />G. Stat pavily'i1D � [ 2 <br />H. Facility's Phone <br />702- 71r"-900-1 <br />1 1. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantity <br />14. Unit <br />WI/Vol <br />1. Waste <br />No. <br />Type <br />a. #40 drRYAZy00U�S7��ry <br />OILY WATER <br />T T <br />l i <br />Stale .. <br />221 <br />EPA/Qther <br />L <br />Stale <br />EPA/Other. <br />4 <br />Slate <br />EPA/Other <br />d <br />5tole <br />wL EPA/Other <br />K. Handling Codes for 'rvas es Listed Above <br />a. M I b. <br />1 Additional Descriptions for Materials Listed Above ' <br />OILY WATER <br />d <br />5. Special Handling Instructions and Additional Information <br />l..iL0VES I ,_ <br />Ci'dlERGENCY PHONE 209-667-x057 <br />1 <br />16 GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignrssenf are fully and accurately described above by proper shipping name and ore classified, packed, ' <br />marked, and labeled, and are in all respects in proper condition for Transport h• highwoy according to applicable international and notia of gov3rnment regulotions. j <br />, I L <br />Yf 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 I•ave determined to be economically <br />practicable and that 1 have selected the proelicable method of treatment, stomps, or dssposol currently available to me which minimizes the presens and future threat to human her it <br />and the environment, OR, if I am a small quantity generator, I hove made a glad faith effort to minimize my waste generation and select the be waste management method that is e <br />available to me and that I can afford. <br />T Printed/Typed Name jj 1.n � iz (S(Pjjrf?4 nat4ra aro r I 1 <br />.. Ge�'j e,y £s i7) (� Month Day Year <br />i �„�� Yi! tnH C rte• : � <br />k 7 Trans oder 1 Acknowledgemonf of Recaip4of Materials <br />Pnrted/Typedoma Signals :e i Month Day Year <br />y <br />i tans otter 2 Acknow d omonl of Receipt of Materials <br />Printed/Typed Name Slgnarwe Month Day Year <br />;9. Discreponcy Indication Space <br />0. Facihil Owne or <br />insed/Typed Nome <br />Is covers+ <br />Signoiura <br />by this monifest except as noted in Item 19, <br />Month Day Year <br />DO NOT WRIITE BELOW THIS LINE. <br />II/991 <br />2 GENERATOR RETAINS <br />