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Stare of Californio—Enwronmmntaf Protectwn Agency <br /> Form Approved DMB No 2050-0039(Expires 9 30 991 See Instructions on bock of page 6 Departmerif aF Toxic Substances Control <br /> Please pant or type Form destgned For use on title 112 Poch)lypewrifer Socromertc,Cah6rnio ' <br /> UNIFORM HAZARDOUS 1 Geneto s u5 EPA 16 No Islomfest Docunihm No 2 Pape 1 EnForrirahOn m Iha shaded areas <br /> is not required by Federal law <br /> WASTE MANIFEST ' f F i- i t of <br /> 3 Generator s Name and Mailing Address A Stab Marled Document Number <br /> 2296804 <br /> o \ i t• <br /> 11—k-11 r r -16 t 1 8 Seita Generator's ID <br /> 40 4 Generator s Phone <br /> N 5 Transporter 1 Company Name 6 US EPA ID Number C Stale Traruparnr's ID aw I <br /> 00 <br /> o AMERICAN VALLEY WAS T£01t C Al !. 01 <br /> OL0181 4 T 4 T 3IJ Traa,park"'Phone00 <br /> +-7'3,'-�•��S <br /> 7 Tronsportmr 2 Company blame 8 US EPA FD Number E Sk t Tronspa#W's ID(Rest 1 <br /> r _ F TrampartWr Phone <br /> 9 oc Name r ros� 10 US EPA ID Number G 6""Fanheye 10 <br /> 30 <br /> Ll <br /> R 19-^ -101010 1119 10 1811161 <br /> q-100 CL.AilS ROAE) 11 Pacslity tPhona <br /> O RIVERCANK, CA 95367 JCJ AlLl 01010111911 g <br /> Q 12 Containers T3 Total IE Unit <br /> r� 11 US DOT Dmeriphon[including Proper Shipping Name Hazard Class and ID Numbers ' <br /> •�S,! No T Quantity Wt/Vol I Waste Number <br /> a stare <br /> NON RCRA 14AZRDOUS WASTE liQUID <br /> � <br /> G {OILY WAFCR i f I } EPA/Other <br /> C%1 f N b sorra , <br /> co E <br /> -4 R _ EPA/Other <br /> v A c State <br /> a ; <br /> 0 <br /> EPA/L3fher <br /> tai i d Sesta <br /> Z <br /> U.1 <br /> V EPA/Odrer <br /> in <br /> to '-tAdd 13muCsrf+z $0 mow"AAW AW" ,,.w.:,` _ > ' ," w, > K. Hwrdling Codec$or Wastesllseed Above <br /> b <br /> U.1 r �u r 3 v t x"„4,,.7 1 .�.�, 4 �, pax, • x • r <br /> 015^ Special Handling tnsrructiorK and Additional Information <br /> 0GLOVrS <br /> --' <br />_=z �EMERGENCY *Hang za4# �8857 --- - ----- - _---_--- - _ <br /> W <br /> j — — 16 GENERATOR S CEInWIC 4TMN I f tpw dacforo Ihat firs conNnfs of Yhu const8rrmm�l aro fully and acarrateh described nbove by proper ship mg nonro and are Classified prxked <br /> CCQJJ morlmd,and lobeted,and are in al!ros{rsete m proper condition for transport by highway according so aWscoble intemaiwnal and nationo�gwernmsnl rsgulaimns <br /> _ <br /> if I am a large quanty generator,I cartify that I have a rom in place to reduce the va6ma and toxicity of waste generated to the degree I have determined to be economically <br /> 0. praclicabis and that 1 hate refected the pmcticabhi riselfrod treahnent storage X dupoeal currently available M me whish mmrmizm Fla present and future threat to human health <br /> and thin Mwironmmst OR,if I am a. I quant4y generator,I hese made a good faith mffort to minimize my waste genwation and selrrcl tai,best waste management mathod that is <br /> walable to me and that I car afford <br /> OPrrnted/Typed Nomm Signaturo L W-nih Day Year <br /> Z11A, <br /> k 17 <br /> 70—FZrter 1 A.6 I of Rempt of Materials ' <br /> W A Pn Na Sigeusfureso <br /> lnonih Day Year <br /> P <br /> aL R I B Tram 2 Ac r of Rpcei of Motereats <br /> TPr-sed/Typed Noma Signature month Day Year <br /> w E <br /> to R <br /> UE 19 Ducrepaney Indication Spats <br /> A <br /> C ' <br /> i <br /> Il <br /> 1 20 Facility Owner or-Operaior Certifrcoimn of rftmpt of hozardous materials aovmred by this manifest except as noted in Item 19 <br /> T Prinied/Typed Name Srgnaturo month Day Year <br /> r I <br /> DO NOT WRITE BELOW THIS LINE. l . <br /> DTSC 9022A 111/991 RECEIVED <br /> EPA 8700--22 Yellow GENERATOR RETAINS <br /> OCT 2 5 700" <br /> 1 <br />