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State of California—Environmental Protection Agency <br /> orm Approved 0111 140.2050-0039[Expires 9.30-991 �.§ge Instructions on backOf page rs. Department of Toxic Substances Control <br /> lease print or type. Form designed for use on afite 11 2-pitch)fytj*riter, Sacramento,California <br /> UNIFORM HAZARDOUS 1• Generator's US EPA ID No. Manifest,Document No. 2. Page 1 Information in the shaded areas <br /> .WASTE MANIFEST ,� n 1 1 of is not required by Federal law. <br /> 3. Generator's Name and Maitirig Address ,� A. State Manifest Document Number <br /> 2339 <br /> C^r 8. State Generator's ID <br /> 4. Generator's Phone <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. Stole Transpo ter's ID(Reserved,[ <br /> Al ERMAN VALLEY WASTE OIL. C A L 00 0- .8 2 78 78 <br /> p D. Tri"porter's Phone <br /> 7. Transporter 2 Company Name B. US EPA ID Number E. State Transporter's.ID[Reserved]' <br /> ,-r f.-Transporters Phone <br /> Q <br /> V r an a"o x 10. US EPA ID Number G. Statoa s u :' 9 0 a f. 18 <br /> 6300 CLAUS ROAD <br /> ?o 8 H <br /> s"RIVERBANK, CA 95387 fC A L 0 0 0 � �' 0 $ 1 Facili� <br /> ]1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) a 12. Containers 13. Total 14. Unit <br /> 1. No. Type Quantity Wf/Vol J.-Waste Number . <br /> _ Nadi-RCRA HAZARDOUS WASTE LIQUID 221 <br /> x. 01 LY WATER) 00 ,I T T O <br /> G EPA/Other <br /> N b. ! State <br /> aD E - - - f - <br /> EPA/Other' <br /> A , <br /> T C. State <br /> 0o O EPA/Orli.,=. <br /> R <br /> d. Stare .° <br /> U EPA/Other , <br /> U.t <br /> J. Additional Descriprionlh1 <br /> 5.6Materials Listed Above - %„ K, Handling Codes.for Wastes Listed Above <br /> .. <br /> OILY ■ A E1r'� - .. a. - .47 7 b. -. <br /> _ r <br /> c. d. <br /> 15. Special Handling Instructions and Additional Information <br /> a GLOVES <br /> EMERGENCY PHONE:209-667-8857 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantiy genarator,I cartify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> 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 waste management method:,hat is <br /> available to me and that I can afford. <br /> Printed/Ty ed Nam -/r Signature ` Month Day Year _ <br /> LU T 17. Transporter 1 Acknowledgement of Receipt of Materials IV <br /> R <br /> A Printed/Typed Name Signature Month Day Year <br /> s <br /> P <br /> 0 10. Trans ,ter 2 Acknowledgement of Receipt of Materials <br /> 0 Lu E RT Printed/Typed Name Signature k Month Day Year <br /> d vr: <br /> R <br /> F 19. Discrepancy Indication Space <br /> -- A <br /> C <br /> L <br /> 20. Facility Owner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> ' DO NOT WRITE BELOW THIS LINE. <br /> I <br /> JTSC 8022A (1/99) <br /> PA 8700-22 Yellow: GENERATOR RETAINS <br />