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0 <br />Please pant or type. (Form for use w ebN (12 -pitch) .) <br />L <br />Form Approved OMB No 20500039 <br />EPA Form 8700-22 (Rev. 3-05) ProvaA edi6me aie obsoWAL <br />F <br />UNWASTE <br />tY ,. GenwabrLUM827878 <br />21'age, d <br />3. Rmpwma Pham <br />. <br />S <br />� <br />0 2 3X16 2 G B F <br />5. Caw Nam and Moft Addaw Cmwabfa SibAdb= (Yd%m tmn ma&V addr®) <br />AMERICAN VALLEY WASTE OIL. INC; <br />P.O. BOX 340 <br />UEL HI, CA 95315 <br />Germabfs Phwc E10Q7J2-4er/9 <br />& Tranpwr, Caryaq' Nam U.& EPA ID Nurtw <br />AMERM.v1N VALLEY WASTE OIL. INC. CALCADMI878 <br />7. Tarapw W 2 Carpary Nana U.& EPA D 1*ur6w <br />8. Daw abd Fa* Name ad Sib Ad*= UK-OIXON U.S. EPA D!*neer <br />73W CHEVRON WAY CA708001'_00_^ <br />DIXON. CA 93020 <br />FmMes Phar tol-6111.0008 <br />9e <br />9n U.S. DoT Dm pfm Coq PmWShgoV Nmm, Need Claes. D N mbw,,10. <br />Cwanem <br />11. Tabl <br />12. IInY <br />NM <br />ad Pa*N Grwq P zM) <br />Qw* <br />WLAtL <br />,a iWab Coaea <br />Na <br />Type <br />y, <br />. <br />1. Nf1KRCRAFU7ARr"Ml�vi.RTFL.IOIM <br />(in I <br />TT <br />r <br />Z71 <br />IUSECI Oft .MIXED Oft I <br />2. <br />2- <br />3. a <br />o. <br />t <br />14. Spadd bmdwm ad AdAmW iph wMr <br />Verba <br />clouts <br />PROFILEN DKt!dODU1 EAA GENCYCVNTACf-Si LVEHUHLR <br />15 GUEIUTOWSOFFERORS CERTFICATKK I lweby dedwe iml M womb aI #n w agmi t m kAy am acm ady dosoiLed abm by 8m puM yfppYg rarm, aW m petlmped, <br />mabd ad bbekdOwaxi d ad ae in al rwpacb m p WmnMm l rVwgmd awadnp b a 6c" irbrrwlwmlarid rwtwd gwmmwbl repeabrm UmpM silo 0 end I am M pmwy <br />E,pMKIw*M,fmwomb dfima opp-dwdormbimbmmdMatbdWEPAAdmmMMdWnw9olCamal <br />Icm* tml Mwq lll*n=m mamrwoidmWadbbCFR 28221(al(rlamamye pmimfy gerwabr)wN)IYl amaawlPwmlY gmi/amr)'mbwCwwakoUbmes <br />RibNfyped Nm/m ( l pA,yw <br />AW p <br />F <br />1 . baenialerne Sliprwib❑ Emwlbom U.& PoN d s "tut <br />❑bwwlb U.S <br />= <br />Twamw owan (brmpwb o*y Dab Wwiiq U.&: <br />rc <br />ww <br />17. TmmwtrAdnsaaedWnmt aRm ocg A6bdeb <br />Tampmw 1 PdbdTyped Nm Slgriwae <br />Nwb Day rear <br />/lei <br />_ <br />ZQnalapamamawlypw <br />Noma sgwbsa mma Owl Yaw <br />z <br />r <br />18 DUMPMY <br />jI& <br />D&MpM Y�tlm Spam ❑ ❑Type ❑ R." El R I ❑ FI Rejwlion <br />MadW Rabrewa Nanber. <br />18L Alban& Fatly IwGmwaw) - U.S, EPA ID NmEw <br />7 <br />U <br />LL <br />FWWS Plba: <br />More <br />1k SW kn OfAWT%a FacKy(w Gemrabr) <br />Morar Day Yaw <br />-c <br />Z <br />H1a <br />Fiazadoue McMd Coda pa, wbe b rmmdwm waab bem.w dagmd, ad mrytlrg sy" I <br />G <br />1. <br />2 <br />4. <br />Demgmbd LaE!5t046OW31w Of MOW Gf r(abrialwvomdbyfmllm twapaa 18a ^ <br />I20. <br />Piil" I <br />y <br />// 71 / ` <br />EPA Form 8700-22 (Rev. 3-05) ProvaA edi6me aie obsoWAL <br />