Laserfiche WebLink
hate of C6{ifornia—Environmental Protection Agency j See IOStTUct1o115 on back of.page 6. Department of Toxic Substances Control <br /> arm Approved OMB No.2050-0039(Expires 9-30-99] . .! ,, <br /> lease print 6r,type, Form designed for use on elite(12-pikh) -'writer. Sacramento,California <br /> ralzpr's US,EPA ID No. Manifasr Documenf.N ? 2. Page 1 ]nfarmalion in the shaded areas <br /> UNIFORM HAZARDOUS isnot required 6y Federal law. <br /> WASTE MANIFEST of 1 <br /> 1 <br /> !1 Generator's Name and Mailing-Address ,. i�J L.✓P lr A;State Manifest Document Number <br /> o r{+ 7+ _ Y 4 <br /> . �E✓' � � �� ��Q�.�.� 8"SraieGenoratorsfD _ <br /> 4. Generator's Phone 1W, , <br /> r <br /> N 5..Transporter T Company Name "G. US EPA ID Number C g State 7raasporter`s.ff](Reserved:] <br /> W D=Tromparter s Phone <br /> 'AMER!CAN VALLEY Env W STT OIC C AlL 0:Q 0.I� � �$ <br /> 7. Transporter 2 Company Name 8, US EPA ID Number E- State Transporters 1D(Reserved:] <br /> J z F..Transpariers Phone <br /> Q gpgsianat Fc� tty Nap ops{$ Addr 10. US"EPA'ID.Number G Stateac�Iy'�ty a ID yq �y �+y p <br /> e+r w.r rrrr.sa x v •�: r rrrr.s,.r s..r r '+.Z 'F'0 i+ " . a7 4'; �7 f <br /> �.,. CLAUSROADH FauPhone <br /> ,..0 RIVERBANK. CA 9636 C -AlI~ O I� 4 1 9 <br /> 12. Containers 13. Total 14. Unit <br /> tj <br /> 11. US DOT Description(including Proper Shipping Name,Hazard CIa'ss,.aad lD Number) No Type <br /> Quantify Wt/Vol I:'Wasie Numybre�r <br /> Z <br /> _ NOt4-RCIRA HAZARDOUS WASTE LIQUID <br /> (OIL.Y'WATER p 'I � G FPA/Other <br /> 13G <br /> E Siete <br /> F4 <br /> N b' <br /> co <br /> co E; . EPA/Olher_ <br /> 1� R <br /> N <br /> A c: Stales <br /> a T <br /> 80 O EPA/Other <br /> R <br /> 'LU d. $tate <br /> Z <br /> w # EPA/Ofher: <br /> tn <br /> V - <br /> 1 J. Additional Descrnptaons far MaleEtals listed A6ave K Handling Codes fir Wastes Listed Above <br /> °' t r ': <br /> w c d. <br /> LL <br /> 1 z 15- Special Handling Instructions and Additional Information <br /> O <br /> 1 zLrOi/ S <br /> LU E:ME14GENC'Y PHONE- 201 -6674M57 <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 tioisified,packed, <br /> 11 marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national governmanbragulafians. <br /> If I am a large quanti generator,I"certify that 1 have a program in place io•reduce the volume and toxicity of waste generated to the degree I have determined.to be economically <br /> o practicable and that I Gave selected the rac6table method of ireotment,srorage,or dispaiat currently available to me which minimizes the present and future threat to human hedhh <br /> v� p <br /> and the environment;OR,if I om a small quantity generator,i have made a good Faith effort to minimize my waste generation and select the best waste management method that is- <br /> o available to me and that I can afford. + <br /> >-• I Prinl*5VT ed Name Signalur/o, s" r �j <br /> Yp , �` fes" r^ Month <br /> / c)I - <br /> Mo Day. Year <br /> T 17.,Trons orter 1 Acknoviled a ban Recei 1 of'Materials <br /> (� R Month Day Year <br /> LU A Printed/Typed Nome Signature �:. <br /> 1 � 9.1 a <br /> P <br /> Lt. fl 18. Trans orter 2-Acknowledgement of Receipt of Moierials - <br /> R Printed/Typed Nome Signature Month pay Year <br /> T <br /> IWE <br /> H R <br /> V19. Discrepancy Indication Space <br /> Z' F <br /> A <br /> 20. Facili Owneror Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. <br /> Signature Month Day Year <br /> Printed/Typed Name g <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A 11/991 Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />