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Slate of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9.30.991 See.Instructions on back `age 6. ,v. Department of Toxic Substances Control <br /> Please print or type. Form designe~ � <br /> aan elite(12-pi ewriter. Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No..; 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS , __ ; ! is not required by Federal law. <br /> WASTE MANIFEST r'I I V C.. ti;t I;. i of '1 <br /> 3. Generator's Name and Mailing Address ""'`'i �;, t, iA. State Manifest Document Number <br /> 21,$07086 <br /> B Stale Generator's ID <br /> LO 4. Generator's Phone <br /> h y <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID Reserved.) <br /> LO <br /> o A.? EIMCAN VALLEY WASTE OIL ,� A 0 {1 0 8 2 7 T 8 D. Transporter':Phone 800-732-4646 <br /> O . <br /> N 7. Transporter 2 Company Nome 8. US EPA ID Number E State TronsPorter's ID Reserved.) <br /> QF,Tropsporter;;Phone <br /> O V �yy�Qad ll� a,sG Stat ac i <br /> p�QW6 ad py'i V7L 3 1CSfil tf"! L'f`: 10. US EPA ID Number �ID <br /> 0. 0 1 0 8 1 6 <br /> Q MIYt�t7�[tif�: : <br /> coZ 5300 CLAUS ROAO H. Facility's Phone <br /> cc <br /> O RIVERi3ANK, CA 95367 A I_ 0 0loll 1910111 6 209-863-8181 . <br /> Q 12. Containers 13. Total 14. Unit <br /> N V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> = NON-RCRA HAZARDOUS WASTE LIQUID <br /> 3 G (OILY WATER) 00 1 T T �� -7 G EPA/Other' <br /> r <br /> oN b. State,,: <br /> 00 E EPA/Other <br /> v R <br /> N A c Slate. <br /> o T e <br /> co 0 EPA/Other.'y <br /> R I L <br /> State � <br /> LU d. anY4' i'S•. <br /> Z EPA/Other <br /> F .c <br /> LU <br /> N J. Additional Descriptions forMaterials,Listed Above {; 1 " s LL r' " ' K Handling Codes for Wastes Listed Above <br /> Z <br /> o <br /> w <br /> Q _. ..., ...,_.,. .-�.i....-.. � ,.,..-.....a.a.�..s,.r i ..W-.w.w- �--'"�,x T.V%.tetw-�c-.r.�j.w.u,.�-�".• :e.�cn- s.,., _.i._ _. .1^._ .. <br /> Z 15. Special Handling Instructions and Additional Information <br /> a GLOVES " _.. <br /> Z EMERGENCY PHONE 209-887-8857 <br /> 4. <br /> W <br /> N <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 /> Vmarked,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 quontiy generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economically <br /> a 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 smaquantity 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 that I can afford. <br /> }0 Printe e - Signature Month Da Year> <br /> Z <br /> W T 17. Transporter 1 owleclement f cei t of Materials <br /> � R <br /> w i Printed/Type Na s Signature 1,> 7onth /Day or f <br /> w i -,-) PC <br /> W 018. Transporter 2 Acknowle4ementpf Receipt of Materials - <br /> O T Printed/Typed Name Signature Month Day Year <br /> N F <br /> Q R <br /> V 19. Discrepancy Indication Spate - <br /> Z A <br /> C <br /> I <br /> L <br /> 20. Facili Ownosqr Operator Certific of receipt o ozordous materials covered by t is�jnanifest except (noted in Item 19. <br /> T Printed/Typrh:*�// <br /> Signature Month-761 /, Goy _ ea 1, <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Green: TRANSPORTER RETAINS <br /> EPA 8700-22 <br /> r`• A <br />