Laserfiche WebLink
Jan 1711 09;01a Julie Htaber 209-668-3880 p,1 <br /> Pleasa 'nt or type,{Form designed for use on fall 12-pll typ wrl[er.) Ill Farm <br /> UNIFORM HAZAR04US 1.Generator It)Nrmttie 2:Pa 1 of 3,Eme Approved.OW No.2050-0039 <br /> ge rgerry Response Phoma :=: nifestTrecl Number <br /> WASTE MANIFEST C A LO 03920173 FLE <br /> 5.L*neraiars <br /> time and Mall Add <br /> rens carr - <br /> Brat a Sita Ad as d di Brent than rnaiiin address <br /> E 9 ) <br /> AMERICAN VALLEY WASTE OIL.IhIC <br /> P.O BOX Sao <br /> t; Gena amts Phone:DELHI,CA 95315 209-887-8857 <br /> rarssporter 1 Compain-yName a US.EPA ID Number <br /> AMERICAN VALLEY WASTE OIL- <br /> 7.Trwuporter 2 Company Name <br /> U.S. ID Number <br /> 6. <br /> F <br /> ruEad Fal Name and Bile Address U.S,EPA ID Number <br /> [*-MON <br /> TM CHEVRON WAY <br /> l GTQB 0012E 02 <br /> M"-cA OW20 707-89008 8-6 . <br /> Faa horld: <br /> ga, 9b.U.S.DOT Descriplon pncW4 Proper$hipping Name,Heaard Clara,ID Ni mbar, a O.Canto mess 11.Toal 12.Unit <br /> pta and Packing Group{dany)1 rye WAV.AV. 13.waste Codes <br /> o t N6"CRA 1"4AZARDOLJS WASTE LIQUID229 <br /> USED OILY MATER <br /> z 2. <br /> w <br /> 3, <br /> i)Ifti y�a�has Oe ai:prap6atc <br /> �:*:c•;<�rrcetir�Vous.waste,and has reeeiveai the <br /> 4 Spedal Kandinhsuucb'orls and Additional lntormation <br /> mule#DKIQQaBx <br /> TRUCK* T <br /> 0, GENERATCR'SlCFFEROR'S CERTIFICATIDN: I hereby dill that the contents of this oonsignment are Billy and accurately described above by tie propersldpping name.and are dassified,padwged, <br /> rrarted and labeledlplamrded,and are In 61 respeas In proper oorejon for Iransport eawrd"irV td applicable international and nationalgovemmental ragulatiorm.If export ahirrment and I am foe Pr rary <br /> Exporter,I oartily that the contents or this consignment conform a the terms of the attached EPAAcknowledtynenl of Consent; <br /> I alrtily that the waste minlmir l statement ldanMed In 10 CFR 282.27(s)R I am a Iarge quantity generator}or{b)Of I am a amatl quantity generator)is true. v <br /> PrAofrypw Nam V" My— Year <br /> i6.Intemaboul Shipment& <br /> ❑Imporl to U:S. ❑Ezrpom from U.S. Pod of entrylerdt: <br /> Treru ler s'nitNe Ior and : Data twvI U.S.: <br /> 17,Than*orerAcXnwAiedgmontaf Reoept of Aieterlala <br /> Transpo ier 1 Powdrryped tameSignal Day ear <br /> ll Rill <br /> Q TransporterrTyped <br /> 2PrintodName Month Day Year <br /> A.D''screpency <br /> 10a i3isaepancy Ind oat o i Space . ❑ Quantity ❑TWO ❑Regdue ❑Per%l Rejection ❑Fut Rejemon <br /> manIl l Raieranoa Nrrrber. <br /> 18b.ASlerrale FedAy(or Generator) U.$.EPA ID Number <br /> o+- Faa s Phare: <br /> LLJ 1 S3natureafA[lernale aciliry(orGenerd6ori t,Scnth Day Year r <br /> z <br /> 19.tlaxamtous waste Repdrl Management Method Codes Q.e.,codes for hazardous waste trw4ent,disposal,and reuycring systems) <br /> 1. 14 1 t 2. 3 d. �L <br /> 20.Desgnaled Facaty Owner or Operator:Certifiratfon of receipt of hal melerials covered by tie nwifeal except as nate Item Il i <br /> Pry ypad ame ignatin" N Day Yeas 77 <br /> �See� cis : . 4k IZ. 34 f D <br /> EPA Folin 8700-22(Rev.M5) Previous ditions'are obsolete, DESIGNATED FACILITY TO GENERATOR. _= <br />