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' of call ornda—Environmental Protection Agency <br /> Approved OMB No 2050-0039[Expires 9 30 99] �� See Instructions on back of pop-" Department of Toxic Substances Control <br /> sa print or type Form designed for use on elite(12 pttchf lyp I Sacramanlo California <br /> UNIFORM HAZARDOUS 1 do orator s US EPA ID No Manifest Document No r 2 Page 1 Information to the shaded areas <br /> is not required by Federal law <br /> WASTE MANIFEST C L p ,� (r� -�� '- ") of I <br /> Fl+� �y {� A State Manifest bowmen!Number <br /> r 3 Generator s Name and Mailing Address (� ( (Y-14 a,, r-`yko C a P�[(�y y 2 3,3 9 2 9_ 0 ' <br /> B State Generator's ID <br /> to <br /> L' <br /> u1 4 Generators Phone (26Q , n n <br />'➢ n <br /> CV 5 Transporter 1 Company Name 6 US EPA ID Number C State Transporter s ID[Reserved <br /> LO <br /> a AMERICAN VALLEY WAS HE OIL 0 A f. 0 0 0 8 7 8 78 D Transporters Phone 800-732-46415 <br /> 415 <br /> d <br /> co 7 Transporter 2 Company Name 8 US EPA ID Number E State Transporter s ID[Reserved <br /> F Transporter s Phone v <br /> a <br /> (J I �S' IiIKr� a7jS (3 6 t 10 US EPA ID Number G Skat!r�fiac ty tID o O 0 -1, 0 09-1 0 yx�yM1 <br /> a 6300 CLAUS ROAO <br /> Z <br /> p 111 s Phone <br /> RIVEf�PANK, CA 96367 C A L. 0 D 0 19 0 I3 1 8 H Fac l�09^8f3"181 <br /> 12 Containers 13 Total 14 Unit <br /> 11 US DOT Description(including Proper Shipping Name Hazard Ctass and ID Number) <br /> YPe Quantity Wt/Vol 1 Wash Numba� <br /> ° NON-RCRA HAZARDOUS WASTE LIQUID State ill <br /> 3 G (OILY WATER ) 0 0 1 T C t� f G EPA/Other <br /> 1 w <br />' 0 N b State <br /> co <br /> coo E <br /> v R EPA/Other <br />' CIA <br /> o T c state <br /> 0'0 O <br /> R EPA/Dthar <br />' w d Slate <br /> H <br /> Z <br /> w EPA/Other <br /> V <br /> su <br />' J Additional Descr ptwns For Materials Listed Above l K Handling Codes for Wastes Listed Above <br /> 011.'d WATER a <br /> A a <br /> - <br />' Z <br /> 0 15 Special Handling Instructions and Additional Information w <br /> a GLOVES <br /> Z FMENCENCY 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 /> Umarked 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 quanhty 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 /> n practicable and that I hove selected the practicable method of treatmentstorage or disposal currently available to me which minimizes the present and future threat to human health <br /> w <br /> and the environment,OR if E am a small quantity generator I have made o good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford <br /> O <br />' PnnViTyped Name Signature y Month Day Year <br /> f N <br /> Z 'd yJr ,� �f �rriy J�y ' r�� ✓✓`� 'f,cY•��.,,.�_"w. �.9r�`.,,.�'� < <br /> !L TR 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> sx R Pnnlgd/T ed Name r Sign ure + may j Month Day Year <br /> ✓ J �]r <br /> 1 . :� . <br /> P i <br /> I.L.st- a �18'"'1rans rter 2 Ac~ ow ed e e o R ei t of Materials <br /> RT Printed/Typed Nam. Signature Month Day Year <br /> w <br /> V) E <br />' R <br /> U 19 Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> L <br /> 20 Facility Owner or O erator Certification of receipt of hazardous materials covered by this manifest except as noted in item 19 <br /> T Panted/Typed Name Signature Month Day Year <br /> Y <br />' DO NOT WRITE BELOW THIS LINE m <br /> DTSC 8022A (1/99) <br />' EPA 8700-22 Yellow GENERATOR RETAINS <br />