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:-ere of Calitc
<br /> ' mic—Environmental Protection Agency
<br /> =crm Approved OMB No.2050-0039(Expires 9.30-99) See Instructions on back of ge 6. Department of Toxic Substances Controi
<br /> .ease print or yoe. Form designed for use on elite(I 2-pitc I iter. Sacramento.Caiifornio
<br /> UNIFORM HAZARDOUS 1• enerator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas
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<br /> WASTE MANIFEST ( is not required by Federal law0 S 2 a�
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<br /> 3. Generator's Name and Mailing Address
<br /> Sto�t&f :onifest Docr.umFenf P=ub
<br /> eDi5tribuL101 kepo}.San Uuj ya � .4 9 8 9 3 2
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<br /> B State Genorarors ID �' a s�� x 3: �
<br /> " ( VC_k+Vnj CA 95a9i-o-7ro
<br /> A. Generator's Phone kq)
<br /> 5. Transporter 1 Company Name `I 6. US EPA ID Number C State Transpo¢or's ID Msit xkt y '
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<br /> AMERICAN VALLEY WASTE CIL L 10 10 P P 12 171 81718 DhTransporrers�Phone
<br /> 7. Transporter 2 Company Name 8. US EPA ID Number E State T
<br /> _ P P � rans porters IDP f r??v
<br /> J F Tronsporters Phone
<br /> J 9. Designated Facility Name and Site Address 10. US EPA ID Number G State Fac,liVs 1D,; tis `1r� Y' t
<br /> z INDUSTRIAL SERVICE OIL CO, INC C A 0 9`;9`4 e$' 2 7 +8
<br /> Y 1700 S. SOTO ST H Foc,lify's Phone
<br /> LA CA 90023 A I D 10 1919 14 12 171 01 8
<br /> 1 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit ,r+
<br /> J No. Type Quantity Wt/Vol I Waste Number
<br /> a- State
<br /> NON-RCRA HAZARDOUS WASTE LIQUID r .._1223
<br /> G (OILY WATER) 0 0 1 T 0 G EPA/Othiio��
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<br /> ? R I EPA/Otr : ori''m
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<br /> 1 Additional Descriptions for Materials Listed Above,:, :. _ P
<br /> P , F fC Handling Codes foi asps Listed,46otis
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<br /> a sY ®ILY-WATER ,
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<br /> k . y n*;;,i s r ;S (S`.'r{';+. ••°1A C .find+s7 f L r},1>i5,
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<br /> � �:i,¢8.6:t�Y.^!`,;t`<'a�3'*:ar�"-f,f k.m[;;�';i�n �•s-.'+S•'�; �``' st,�"P'"y.�%�,,...,tE�'ry..•�i'ri�a+A�ts�,i.,�.�';;�&a;��'".V��kk.'�+�ai;°`•�wmS'�"a.*;L�s�.z�„-� .{+�' �'.. o�"'. .,w�G� k.-.
<br /> 15. Special Handling Instructions and Additional Information
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<br /> GLOVES
<br /> EMERGENCY PHONE 209-667-8857
<br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of X-tss c'pnsfgnment are fully and accurately described above by proper shipping name and are classified,packed,
<br /> marked,and labeled,and are in all respects in proper conn ifion for tronspo?t by highway according to applicable international and notional government regulations.
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<br /> If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicoliy
<br /> practicable and that I have selected the practicable method of treatment;�stordge,or disposal currently available to me which minimizes the present and future threat to human health
<br /> -and the environment;OR,if I am a small quantity generator,I-favIe ihade o good Faith effort to minimize my waste generation and select the best waste management method that is
<br /> 5 1available to me and that 1 can afford.
<br /> Printed/Typed Nome Signature on Do ^ a
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<br /> 11 T 17. Transporter 1 Acknowledgement of Receipt of.vlateriois
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<br /> A Printe y ome' - Signotu _ Month Day ear
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<br /> a 18. rens orter 2 Acknowled ement of Recei t of Materials
<br /> TPrinted/Typed Name Signature Month Day Year
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<br /> J 19. Discrepancy indication Space
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<br /> ) 20. Facility Owner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19.
<br /> Printed/Typed Name s` Signature Month Day Year
<br /> DO NOT WRITE BELOW THIS LINE.
<br /> )'SC 8022A (4/97) `/hite: TSDF SENDS THIS COPY TO DT5C WITHIN 30 CAPS.
<br /> ?A 8700-22 To: P.C. 3oR 3CCC, Sacramento, CA 95812
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