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�t"CBrfornia—Environmenlal Protection Agency <br /> Fo �`reRIOMB No.2050-0039(Expires 9-30-99) See Instructions on back of pr 6. Depa ment of Toxic Substances Control <br /> P eat se winl type. Form designed for use on elite(12-pitch)yp Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Inform ion in the shaded areas <br /> UNIFORM HAZARDOUS X <br /> WASTE MANIFESTp L p 0 7 r -) ai is not r quired by Federal law. <br /> I <br /> 3. Generator's Name and Mailing Address J A. Stale Manifest Document Number <br /> AMERICAN VALLEY %t,A-TE OEL INC <br /> D P.O BOX 340 �L B. State Generator's ID <br /> n <br /> �1tN1 7 tl-4it4j DELHI CA$5315 <br /> n <br /> A. Generator's Phone ] r <br /> N 5. Transporter 1 Company(lame 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> n <br /> D <br /> D A iM RICAN V n, , E"'" WjA STr. n=1 ` y D. Transporter's Phone 800-732-11C456, <br /> tr_ , r t ria ��r vvrss u <br /> Q 7. Transporter 2 Company Name 8. 1 S EPA ID Number E. State Transporter's ID[Reserved.] <br /> QF. Transporter's Phone <br /> J 9. Designated Facility Name and Site Address 10. SIS EPA ID Number G. State Facility's ID <br /> t NDUSFRIAL SERVICE COIL CO, INC: At D O 9 9' a 1 t� 11 <br /> r 1700 S. JO rQ 5T H. Facility's Phone <br /> CA 300221 r, A ID 10 19 L' 18 562-5913.5577 <br /> -i <br /> = <br /> 11. US DOT'Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total I A, U it <br /> J <br /> No. Type Quantity Wt/V I I. Waste Number <br /> ° State <br /> C NON-RCRA HAZARDOUS WASTE LIIPUID 221 <br /> G ( USED OIL ) 0 0 1 T T rJ EPA/Other <br /> I <br /> j N b. State <br /> O j <br /> 7 R ^� ! EPA/Other <br /> N A <br /> T C. <br /> Stale <br /> o O <br /> EPA/Other <br /> Y <br /> U d. Stale <br /> 7 <br /> U <br /> EPA/Other <br /> U <br /> J. Additional Descriptions For Materials Listed Above K. Handling Codes for Waste Listed-A Dove <br /> USED OIL&WATERj 01 b. <br /> Y <br /> C. d. <br /> J <br /> I <br /> Tl I <br /> 5 15. Special Handling Instructions and Additional Information <br /> i GLOVES I <br /> EMERGENCY PHONE: 209-667-$$57', <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore fully and accurately described above 6y proper shipping name and re classified,packed, <br /> = marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government re 3ulations. <br /> J <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 dete mined to be economically <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and fu re threat to human health <br /> and the environment;OR,if I am a small quantity generator,I hove made a good faith effort to minimize my waste generation and select the best waste n anagement method that is <br /> Y available to me and that I can afford. <br /> Printed/Typed Name Signoture onth Day Year <br /> J J <br /> J T 17. rons orter 1 Acknowled ement of Receipt of Materials <br /> � R . <br /> J A Printed/Typed Name // I Signature / k onth Day Year <br /> P <br /> a 18. Transporter Acknowled ement of Receipt of Materials <br /> A Printed/Typed Name �Signoture h anth Day Year <br /> R <br /> i <br /> 19. Discrepancy <br /> F Indicati�.5pdce�'^•�'.. i <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name tura onlh Day Year <br /> DOOT RITE EL W THIS L E. <br /> Yellow. TSDE SENDS THIS COPY TO GENERATOR vviiiiir' 3u i <br /> DISC 8022A(1/991 (Generators who submit hazutdous waste For von pore ovt-crsi�ro <br /> EPA 8700-22 produce coinpleled copy of Ihi; copy curd send to 015C ..itn�n i -_ <br />