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Stale of C dvFo, ++d—Environmental Protection Agency <br /> Form Approved OMB No 2050-0039(Expires 9 3q 991 See Instructions on back of page 6 Department of Toxic Substances Control <br /> Please print or type Form designed for use on elite 112 pitch)typ^ +er Sacramento California <br /> UNIFORM HAZARDOUS 1 \,.Mater s US EPA ID No Manifest Document No 2 Page 1 In'ormahon in Ile shaded areas <br /> WASTE MANIFEST /� r`{ f 1 is nor required by Federal law <br />' o 0 j i I .1' of I <br /> 3 Generator s Name and Mailing Address A Nie i C`1 e y A State Manifest Document Number <br /> UL "I ��c 23392�1.9 ' <br /> 8 State Generator s ID <br /> � 1���� off` C,)L <br /> W) 4 Generator s Phone64)11 <br /> CCN 5 Transporter 1 Company Name 6 US EPA ID Number C State Transporter s ID[Reserved] <br /> o <br /> AMERICAN /ALLEY WASTE�)>L A L„ 0 0 0 8 2 7 a , D Transporter s Phone 800-132-4646 <br /> 00 7 Transporter 2 Company Name <br /> P P Y 8 US EPA ID Number E State Transporter s ID(Reserved] <br /> F Transporter s Phone <br /> U <br /> �l4gl�EP #P9I39Ce 9^ 1v`; R '�L O 4 i f} O 1 <br /> k0 US EPA ID Number G Stat a i ID <br /> z 5, 30 )CLAUS ROA <br /> H Facility s Phone n f <br /> o RIVERBANK, CA 9€36 i A I L 0 CY 0 Y � i3 $ 1 16 <br /> V11 US DOT Description(including Proper Shipping Name Hazard Class and 1D Number( 12 Containers 13 Total 34 Unit <br /> No Type Quantity Wt/Vol I Waste Number <br /> Z a <br /> NON RCRA, HAZARDOUS WASTE LICQVID state <br />' j 3IWATER ) I 221 <br /> G <br /> C14 E b <br /> 0 N State <br /> 0 E <br />' Q R EPA/Other <br /> v A <br /> o - <br /> T c State <br /> aoo O ' <br /> R EPA/Other 1 <br /> � 1 <br /> Zd State <br /> LU <br /> l! EPA/Other <br /> i <br /> J Additional Descriptions For Materials Listed Above _ K Handling Codes for Wastes Listed Above <br /> OILY-WATFER - t a fvl b <br /> LU <br /> d <br /> 15 Special Handling Instructions and Additional Information <br /> ;7— <br /> Z <br /> z GLQVE:� <br /> z <br /> Q16 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 /> U marked and labeled and ore 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 generator I certify ihat I have a program m place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economically <br /> Npracticable and slat I have selected the raclicable method of treatment storage or disposal currently available to me w6 ch minimizes the present and future threat to human health <br /> Of 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 /> available to me and thus I can afford <br /> O0 Printed/Typed Nome Sign atu�e Month Day Year <br /> Jar G r / r� <br /> W � � i <br /> fD R 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> A Prinsed/Ty�sed Name _ Signatu e F r Month Day Year <br /> /J / / p <br /> W LLF <br /> P f }f a f+ ra .n. <br /> sL g 18 Transporter 2 Acknowledgement of Receipt of aterials / <br /> TPrinted/Typed Name Signature Month Day Year <br /> LU E <br /> � A <br /> a <br /> V 19 Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I 1 <br /> L <br /> I 20 Facile Owner or O eratar Certilcahon of recei I of hazardous materials covered b this manifest exce t as noted m Item 19 <br /> T Printed/Typed Name Signature Month Dpy Yepr <br /> DO NOT WRITE BELOW THIS LINE <br /> IDTSC 8022A 11/991 <br /> EPA 8700-22 Yellow GENERATOR RETAINS <br />