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H <br />+ Dec 0312 02 :20p American Vail, Jaste Oil - 2f 38-3880 p . 1 <br /> Please print or type. (Fxm Resigned ICT use on elite (12-pitch) typewriter.) - Form Approved. OMB ND. 20500039 <br /> UNIFORM HAZARDOUS I . Generator IS Number 2. Pagelal % Emergency Response Phone 4, Manifest Tracking Number <br /> W MANIFEST tr A L0 0 0 a2 r a 7s y . : uJ9;" 7-ls 57 Op554. 69 FLE <br />�� 5. eneatc�s Name and�P,Aa ' gAddmss - GaneralofsSke Address (Fdilferenlman mailing address) <br /> giAEt OAFS 11ALLEY WASTE OIL NC <br />.I Goeratoes Phole. U.S. EPA10'Numher <br /> 6 Traneporta" 1 Compary Name <br /> r`, ?AERI GAN VALLEY . WASTE OIL CFiLt1�14A#52 'Jr371i <br /> I . Transpoder 2 Company Nare - U.S:E AID Number <br /> B. Designated Facility Name and SdeAddress 1/.5. EPAID Number <br /> i'GaI cHE'rRoirt AY - CATUBPUl :i; {i;: <br /> L010 CA 95h20 ' . 7t1f-Kid?riitNyB - VTOI <br /> " <br /> Facility's Phone. - <br /> gy pb. J.S. WTDescdpdan (includkg Proper Shipping Name, Hazard Close, ID Number, _ .. 10. CanNlners 11 att 13. Yyeele Codes <br /> HM and pecking GrcuP ( Iany)) No. Type . <br /> use aril ±u►x �cf ort. p . a a 9 t t <br /> i 2. <br /> w <br /> c2 <br /> 4. <br /> 14, Special Hancting Instructions end Addllisr I*MaOm - - <br /> GLO V Ii <br /> PROFILE OOKOOOWI <br />'a 7 Rr3lCK # <br /> 16, GENERATOR'SIOFFEROR'S CERTIFICATION: Ihereby dadere that theconunts of fide mnslgnmont are fully and accurately described aba'rrea'y the proper shipping new. and are classified, nackagad, <br /> marked and laboindfoacaded, and are in all Iespedsln proper condition for Iransporl according to appli©tla internationaland national governmental regulallons. if expod shipment and I am the Primary <br /> Expodsc l ceNry that the contents of this consignment conform to fie tormsolthe attached EPAAcknowladgmwd ofCons}1t. I we <br /> I ceNfy that me weal " Tutt statement Ida ' ir. 40 CFR 262.27(a) Itfam alargequattiry genaakrlar(b) (A'l am'p sn:ali qua Ery fie r) s <br /> Generale s10 em s PriI Ird'type a gnature / / ±j6 <br /> f6. lmarnalicral Shipments ❑ ImportNU.S. - - ❑ EYparlhemu.S. - .Port of enwrdi: <br /> z Tars ' nature Fwexaarts and l: Date firmin U.S.: <br /> W 17-'anspxl Adnowled I•af Re lot Mamriats "- _ <br /> K Tanspod 1Pnn'ea Type Name aha orae ml Y ear <br /> I 611z <br /> QTtenspnner 2 PdnlaNTy'Ped Name blinaWra - . Day e <br /> I80. Discrepancy Indicadat Space ❑ Quwgty -❑ Type ❑ Resldu - '❑ Peru RelecBoo - ❑ EUI Refection <br /> Mamfas. Reference Number. <br /> F IBb.Ahornate Fa--igly (or Generator) _ U.S. FPA IDNumber <br /> U <br /> LL Fatril s Phcre: Monh Day Year <br /> IBe. S'gn'et oa of Allemate Fadlity(w GenerabrJ - <br /> 13: Harrdou6 N'asls .ieporl ManagementNtathad Codes (Lo,, codesforharadouswase treatmenS disposal, arM ;yclirry systems) <br /> 4. <br /> 9 <br /> 1. I �(yip 1 lJt 2 <br /> - - 23.Desgraled Facility Owneror Operator CergrcaYonof receipt of hazaNnu maledal covered by Na na r Wpl as led In Item I8a f Day YearYe <br /> Panad+fyped Name <br /> 7RAN5POR7ER'$. COPY <br /> EPA Form '0g22 (ReV. 3-05) Previous edition's_are obsolete. - - <br /> B <br />