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State of Cohfornia—Environmental Protection Agency <br />'Form Approved OMB No 2050-0039(Expires 9 30 99) See Instructions on back of page 6 Deportment of Toxic Substances Control <br /> Please print or type form designed for use on elite(12 pitch)tyr for Sacramento California <br /> UNIFORM HAZARDOUS I\_ ,rotor's US EPA ID No Manifest Document No 2 Page 1 Inforrrsation in the shaded areas <br /> is not required by Federal law <br /> WASTE MANIFEST of <br />' 3 Generator s flame and Mailing Address �/� o `o C,of A State Manifest Document Number 24715135'4 71 5 1 f� 5 <br /> r,# 009-ad 0 8 State Generator's ID YL <br /> A Generators Phone 9,02ka_ <br /> 5 Transporter 1 Company Name S EPA ID Number C Slafe Transporter's ID[Reserved] <br /> co np~s„1�� )�f VALLEY <br /> l.w ¢ ma y Ash E� OIL <br /> ,r� p �r <br /> AM.ERICil N V LLE r�y.�'1VTE OIL V V � D Transporter's Phone + 17`'43•ry,,,�'6 46 <br /> 7 Transporter 2 Company Name 3f 8 US EPA ID Number E State Transporter's ID lReserveed'"]T i. �i <br />�QI I I I IF Transporter s Phone <br /> 9 Desi noted Facility Name and Site Address 10 US EPA ID Number G State Facility s ID <br /> .rSWO CLAUS ROAD H Facility s Phone <br /> RIVERBANK, CA 95367 Al 14 q i 1 191 209-863-181181 <br /> 11 US DOT Description{including Proper Shipping Name,Hazard Class,and ID Numberl 12 Contoinars 13 Total 14 Unit <br /> No Type Quantity Wt/Vol I Waste Number <br /> X a NON-11CRA HAZARDOUS WASTE LIQUID state 221 <br /> ~ G 011,yWATER T T� s ro � C EPA/Other <br /> E b State <br /> N <br /> coo E <br /> R EPA/Other <br /> A c State <br /> T <br /> co O <br /> R EPA/Other <br /> d Slate <br /> V EPA/Other <br /> LU <br /> ! Addigonaf Descriptions for Materials Listed Above n K Handling Codes for Wastes Listed Above <br /> %�,.": WATERt a �a b <br /> LU <br /> °C d <br /> 15 Special Handling Instructions and Additional Information <br /> a <br /> CLOVES <br /> EMERGENCY RHONE"209-667-8867 <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 /> a 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 quonti generator,I certify 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 love 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 that is <br /> °t available to me and that I can afford <br /> Printed/Typed Name Signature �r Month Pay Year <br /> Ls- <br /> LU T i ,' r s ter I Acknowled emeni of ecei t of Materials <br /> C7 <br /> Q A Printed/Typed Name Signature / Month Day Year <br /> S PJB, E Jr f+R e" �r [ <br /> 0 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 1 Pnnled/Typed Name Signature Month Day Year <br /> LU E <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br />' l — <br /> f. <br /> l 20 Facility Owner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted m Item 19 <br /> nnted/Typed Name Signature Month Day Year <br /> rl <br />' DO NOT WRITE BELOW THIS LINE <br /> OMPTSC 8022A (1/99) Yellow GENERATOR RETAINS <br /> PA 8700-22 <br />