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- <br /> �4'y5. ' t:�,�"xY�� z 'k•ragi�� -,5 r. ... _� .30 �R� 1 <br /> merV,a 5{ttpmerit`®ate. f <br /> Driver Signature(Prints <br /> ;CkY,Stara,Zip <br /> # <br /> Sibstruck'?hone. '6 , <br /> p PO# 1 <br /> Product Wftft <br /> f ; <br /> Haza coos <br /> Code CA Manifest go l <br /> tion RCRA ' <br /> rdmrs Waste Liquid{UsedQuantity units <br /> Price <br /> Qg}.Lubrt(ng 221 Amount <br /> Non RCRA <br /> Hazardouj wasts;f_ i.d(Used <br /> tag}:t - G� � <br /> ndu5tr 221 t t <br /> Non RCRA H ; <br /> azartk�us Waste.Ll*(dose . .. <br /> A&►io>iveAr } 134 Gar as <br /> .on-RCRA HazatUaus Waste L' ,� <br /> p�,, quxl{01!&Water}• .221 Gal c..: ; <br /> ,von'RyrV'{ <br /> HZaIUS Waste SIM Contaminated wi8t Used 0N 223 Gat rt <br /> Orained Used(M F Drum(s) (' <br /> Drums) <br /> Empty Drur>(s} <br /> T! rtaGort&Truck Tkne <br /> Hazardtw test , r <br /> iters g <br /> ��ts wffl be ed on MIs Iif�Receipt(tnvpica T <br /> �p�Consor <br /> —Y GE at the PER[ODICRATE 1: � a n me i th of the Month � I' <br /> per month,which is the <br /> ANNUALPFR RATE of tom• $e Pmt due Yptap a ! <br /> signing this receipt,the Generator <br /> ermined by the generator,to he economically t a Program <br /> has b0 estabrished to reduce <br /> relator certifies that all Hazardous Waste ' the volume or uan <br /> Wail on this Con Q �'and toxicity of the he 4 <br /> Manifest Receipt is profited to <br /> hazardous waste a t <br /> 1 <br /> te:Geon meet the wast® <br /> rte�lis t ! <br /> Sew I-a Y, herebyted above. r <br /> anent of Inc..used'oiP may be than advises the Generatorthat X <br /> 'required to curt sported to a facility that is required to com <br /> pIY with the more stringent p Y with federal 's{Generator's signature) -�i <br /> ess used o!!are required to meet thoseuffemenfs aPpllCable to hazardous waste�marta ons applicable to man <br /> is Theis inGude more stri more� agement of used oi!butthat rs ' <br /> !osure and ngent teak deisctPon an�clem�uirements,ands 9ament farxgties. California fap7' <br /> accidenfa!releases. 1t�la prevention °�out-of-state facigtices that process �that handle or � '� <br /> end not these mare �!to send �tu►+'ements,engineering�ilifk%ahona of tank int used og ado meet those <br /> stringent requiremetns, used oil to aur of state facilities that comply on requrre- � � )+ <br /> egrity,and financial assur , . � i <br /> ThFs notification Is for info �'"�the Federal used oil ane � � ` fi <br /> enation on Low. <br /> river f 17 gement sf�anc ' ii <br /> IY ry DSignature X <br /> ture of Generator;Representative or <br /> . 9Ht of Generator. <br /> f+ <br /> AJS <br /> Filter <br /> Processing, ( E- <br /> inc. CRt Re%yoll i [ <br /> 15131 E.Clark Avenue,Bldg. <br /> Indy",CA 91745 E 10f tie Drive <br /> {i26-33i <br /> 29-333Wnodvigile,:M 94928 <br /> -5817 . <br /> 7164983383' <br /> DYWIng, L900 X7432 KftR 000929TS4j Address: i t i l. <br /> ng <br /> Claus padO T�+fsfer 5300 Ramos EnvironmentalCRY.sta*Z;P: <br /> Riverbank,CA 98367 '1519 S.River Road P <br /> 208 <br /> 863.818, west Sector s. <br /> CAL9999190817 mento,CA 86699 Phdne: e� <br /> 918371-5747 <br /> CA000400365s iO <br /> EPA lo: �T i <br /> AV ft <br /> ... ars :.• ,� � .., V�`�L" ^».,a <br /> i <br />