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Sloss a Ca 6rneo--EnvrnH+me.,lb Pr014tivn Agency See Instructions an back of page 6- Department of Toxic sub.rantes Comro <br /> Farm Appraved OMB No 2058-009 IE*nss 3G 991 Saaamenw,California <br /> Please prem or type Form designed for vu w4file 112 pd*6%WveI <br /> 1 Csettarators US EPA 0 Nn. Manifest Document Me 2 Page I Infornwttan in the shades areas <br /> i UNIFORM HAZARDOUS � D rs not roqu,red 6r Fedmral law <br /> WASTE MANIFEST of <br /> 3 Generator s Name and Mwltng Address /� A State Months!pocutee+tr Namber 21653098 1�S 5 3 0 (*� <br /> P(0) T'.J r B Slain Cents is ID R y� <br /> i h ; Co <br /> vS d Generator's PhomI W77�57 ,j/,� <br /> IN 6 US EPA ID Number C Slaw Tre espatur's ID($omrr+!i 1 <br /> i cr 5 Transporter I Company Nome <br /> o jk1AL �t 0AtN VALLEY WASTE 011 A L U 0 v d L f tF t a D rrar,fpat.rr Phan. <br /> m 7 Traasparter 2 Company Name 8 US EPA ID Num6rr E State TranaQsuter s ID(Re <br /> Oct F Transporners Phone <br /> i V :Qi { r,+d► ( a �N► �{ 10 US EPA ID Num6sr G StaUrfir <br /> z 5. 01) CILAUS ROAD H Facil.ty tu`i <br /> � -$1$� <br /> i UI a IRI VERIJAtNK, CA 95367' _ � 0 t3 i ,� t. Y :• <br /> 0 12 Containers 13 Toicl 14 Ilnrt <br /> Q C%ji i US[50T Description{utdudsrtg Proper Sltrpptng Kane Hurd Closs and ID Numberl T QuantityWi/vd I Waste Number h <br /> V Stare <br /> i z a <br /> i+JQNi I;CRA HAZARD US WASTE I_IQUtO <br /> t OILY WATER 0 � � r T � L EPA/Other <br /> 3 � stat. <br /> a 6 <br /> i EPA/Other <br /> I <br /> m E <br /> C%v A slat°= <br /> C <br /> o T EPAYOiher <br /> o <br /> Sb1. <br /> � w o <br /> t M <br /> Z SPA/011ier <br /> V <br /> i N J Addthonai Descnpeans for Motmrfais LKtod Abore K HadlIng Gode �,her Wastes bad Aha+e <br /> Z OILY WATE9 0 1 <br /> o � <br /> cin c d <br /> w <br /> i , n <br /> J <br /> a <br /> z 15 Speool HorAltng instructions and Additional Itdormdton <br /> O <br /> r Y GLOVES <br /> i ( z. EI�RCENC7 PMQIvE 2!]8-687-8857 <br /> ( r <br /> s— ande_ra r rhipp�+ name and an ciossrFivd packed <br /> Q 16 ENrIE�70�Jabel d�aru+dyur mal Peds <br /> in p trolwnc�a condition for e corlivintsof tr iamsport"y hrg6 my amism core lecording ro ppI'ea�tbad na�eal ondP�twnal gogvsrnmom reguld,anr <br /> [S to <br /> _ y <br /> If 1 am a large quashy generator I cantly shot I have a m m plow to retied the vaf mu od toxicity of vvma mie lft yrh ich enxe•he prminnt a�tu e throat to human healtllh <br /> r a- praeticobie and that I=saiectad the pradrm6le=.Pd�aatma+t storogv or asposai currently available waste geaarallon and select dra 6*1 rash maaa9esrrent Method that es <br /> 1 and the itmranmonr OP if I am a small gmantIty genoratar,t haw made a good faith*Hort to rernt mze Cry <br /> O ovaJa6t*to me anti <br /> that 1<an afford <br /> t /T jed °�.�f✓� 5 �� f ��1 ir.--^� c✓I �iJ c <br /> V T' <br /> t W T 17 Trans rter 1 Achrrow{ad menr of Roc t of M.Wer als <br /> ' na M /Typed Na 5r9"a <br /> L W <br /> u„ 4 18 Trent rter 2 Aanewle set of Rmcet t of Maierialr Month Day Yet <br /> F Signature ' <br /> 1 Pnnfed/Typed Name <br /> r u.r F <br /> A <br /> V19 1]rsereporrry Indication Spore <br /> F <br /> A <br /> r C <br /> t L h ous molenoit cowed h Iters tnantfrst tee at noMd m ltem 19 _ <br /> 20 Facile Owner a O otor Cernficahar of rota of axard Mondr Day yo' <br /> DO NOT WRITE BELOW THIS Ll E. <br /> DTSC 8022A 11/991 <br /> EPA 8700-22l <br />