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N N <br /> Cn <br /> ZI O 0 0 <br /> G) O �. <br /> � O <br /> (( AAMERICAN VLLEY <br /> Yr Q <br /> WASTE: OIL. INC. <br /> m <br /> U) oleak pn-[:'r tiPe Form Approved.aMB N9 20"134 <br /> LNI,FIIR HAZARDOUS E�> r.briD Nar'n,re' 2.P.- 1 or !.en.W,wAaP°rrTe Phone 4,M�nlhal Tnclk�inq C <br /> MANIFEST C'�- 1 2U�S22]IT1 ,, 1,J �J�J.7.7 lai..I ff <br /> aHiid,w km—!M E<x2fi{�IVi CO.-PAANI ECA <br /> 3219PRECKE"'`3AVEMANE ECA CA N57.k1AMkM16:.Wy/1t.LtYWA51fkVt1 Wl; INN ZQ-V tryi;AfUuu 1 r5W-a 7UNTr x' >krJK611W1Y1E.1ce.SLLSVt•KY ti'[yIFM:.,INL. <br /> - .r:HareantlSrte 4dJre$ U.S EPAIU Nember <br /> - 4 UNA S'!S LLL A:'RfMEf r l/MT.r <br /> I :'!OE 1.9TN S7 Uj <br /> If+ ,, .�w• `rte <br /> - _-*C�rrpayr pnryulrg Proper Sruppnq Nemo.kazard Class,ID Numha.. r0.Containers 11 7ora1 t21 lleil t3 wnsre C�e9 <br /> 3r 0III onyll No Tyle Quantity wrNoi <br /> RA AKA�ARlvarr - <br /> AT <br /> r-r <br /> (7 <br /> It <br /> Y Nandhrn i�.sl..,;:.c.n5 anr3 AddiliONel hrformapon <br /> �PR+_yLU-�0Y�t 4NN6 A11Fi0iLfltN1 b <br /> i5 A,7p�fpFFEROR S CERTWICA710N:thereby tlec'Iase prat the contents of this consignment are Wily and accurately described above by the proper shipping name,and are classified,packagEd, <br /> rA711eC Arid Iglefedplararaed and are En all respects in proper wndilion for transport according m applicable imtemaponat and national governmental regulaponstt esPon shipment and I am the Primary <br /> E0011N.,,c&*Plsr the a IsnFi of this consignment canfarrn Irl the terms of the attached EPAAcknowledgment of Consent. le <br /> t�,tY[pre rraare nknrm:atior-;falemenl idenEfied m AC CFR 262.27{al(n I am a large guenaty generaWr}or 161 U1I am a smap quanpty generator.)is true Month Day Year � <br /> Signature <br /> /�',ypTab/y0elkprs PnnleMyped Name <br /> me <br /> i <br /> ;te <br /> NMri»u w S gintenis El pnPmY U.5 ❑Export from U 5 Pon of entrylelN' <br /> Dale Veamg U.5.' <br /> rr r,,,orW egrM6, ONrolpmlk�NTl <br /> Ir ,-7,arMpptrpdpgplprJprrmE ofRexept ce mate," Month DaY Year 'li- 0 <br /> �r 7 Name _ Signature / .tel <br /> I , : <br /> ! !e Month Day near <br /> Z T.yrblfet 2 PrinlitifflTYW Signature <br /> E s <br /> '6 Dwepancy ❑FuIIRelsUrun <br /> ?&a.0luJeua'id1'Nrd1WODR Spmte ❑Quantity <br /> ❑Residue ❑Partial Rejection e� <br /> Mantled Referenze Number: <br /> US EPA ID Number <br /> ton FJILana4s Faa81y far Gerleranorl <br /> ci 3MT <br /> LL Faolrrf Pnmre _ Month Day Year <br /> LQ ?gc SEgoatureofABwrra6pFacili'Ifrenefstlx} <br /> a` <br /> z <br /> ,g Hazardous Vbs$e Report Wnrigem1em meow Cad" } Notice:State of California requires -" S� col M <br /> 2 generator to photocopy and mail to ' <br /> C) <br /> within 30 days: i701fi1 a) a <br /> 1 2D Dcwj,*I&dFaciJoOwWv1—',Bator Cer6ficAMO. P.p BOX 400,S1t.fD111entcl,l.Ai1`,F,,`-i1-1�1� �_ <br /> Panled�7yaed Name C= .. <br /> ; NERATOR'S INITIAL COPY CD <br /> O <br /> 'A arm 8700-22(Rev 12.17) Previous i are <br /> N <br /> cn v <br /> CD W <br /> rn <br /> co <br /> O <br /> N <br />