Laserfiche WebLink
Please pnnl or type.(Form designed for use on e'1 <br /> 11(12-pitch)typewriter.) Form ApyroYed OMB ND.2050,039 <br /> UNIFORM HA2Ag000S t.Ganarata IDNt. 2PWl of 3 EmergerkyRnMnse Phare a.Manifest Lacking Numaar <br /> WASTE MANIFEST CALOOD827878 1 800.732.4645 7 3 9 6 2 3 G B F <br /> 5.Gawfalpfs Name and&W ng AdNaa (Ssx<mlots Srta Addas(%d•Wrenl man,wi^ng Oddreis) <br /> AMERICAN VALLEY WASTE OIL,INC. <br /> P.O.BOX 340 <br /> Gasarewc Phano.,800-732-4845 DELHI,CA 85315 <br /> 6 Transposer!Company Name u5 EPAIDNumbel <br /> AMERICAN VALLEY WASTE OIL,INC. CALOOOB27B78 <br /> 7.Trabpate,2 CO wally Nana US EPA ID Nomba <br /> a.Dmgmwd FadTdy no"and sol Addrou , <br /> OK•DIXON u 5.EPA ID NumSar <br /> 7300 CHEVRON WAY CAT080012802 <br /> DIXON,CA 95620 <br /> Fad s PAOra 707.693,M <br /> gy 90.US OOTDeunpdM(adWmg p,aae Sabping Nama.Huam fhs410launaxr, to,Canmmo,e Is,14W 12.Ural <br /> NM arA Padaq Groap(d any)I No. Type Oyand!y mm '+vlasle Codes <br /> z t' NON•RCRA HAZARDOUS WASTE LIQUID 0D1 TT hO 223 <br /> (USED OILY WATER) V <br /> z 2 <br /> W <br /> fO <br /> 3 <br /> C <br /> UG 10 2015 <br /> 14.Spatial Handvq Wtnueons ad Adddaa!Inlamaria, <br /> PROFILE#DK100082 UCpf TU r1CD8 QTAACKIT <br /> EMEEROANCY CONTACT STEVE HUBER <br /> 15. GENERATOR'S!OFFEROR'SCERTIFICATION:I!embydeclara tMl the oftrrs ep!ngnmenta,eW.lyard acaaateF dewbed above by file p:oper,tippmg name,Ord are dassifad,p WgN. <br /> rrarked andtabeki dlpauKed,Swale inalfespects m paper cOodRon la'vanaswl awa,d;ng b app!ub!e x,M,-naaa,aland nalioru!9we.TnanMl regdalina If eaPM skpment a,d I am Oa Primary. <br /> Eapodar,I UHFyNaI g,e CM!enla dmM oahUmranl aanfrem Ip;na Terms oflae alMmed EPAAtanowiodgman;dCansen: <br /> I ceRlry W!No waste ni;nMtieaSalaWlBlnaN ManNadin d0 CFR 281.17!e)[dlama M,pe Ruanarygenera;a) j(dlamaima!1 WanYty Barer True <br /> .UDMrU Pnn + M [. i y, Ye <br /> 16 ameealal b,yrran4 ryry <br /> 1„Jlmpxlb U.S. 1_I Erpal ham U.6. Pal I"v'"U,$ <br /> Lronapwla e'gmNM hla iapalf ally).. —.._-----.._ <br /> Q" 171ran9 _br 0k ' ... _._. DIM faAwq.U•S.; <br /> 1 '+`+ adjraaald Retedld Maiatia:s <br /> _ s. y 4 <br /> FT <br /> ♦ /y}+� ✓� <br /> do of )pbd NOW - gipnANro MmN Day Year <br /> 1 <br /> la.Oaueparcy _� t f� <br /> tea.0isaop¢ecy!ndmdSa,Spaa OVanfny IiY,e 0Road. GI <br /> ❑Pasdil RescWn Fud Rekrdon <br /> sgE Mf"le Fadiy(or Genma!w) Madfes!Re' Number <br /> .-a 0.5.EMO Number <br /> v <br /> W FaG:lys Phone: <br /> y�j tB.:SgnetaeolNemafo Fedtty(a GercvW) <br /> Umth Day Yee, <br /> 2 <br /> h19 flaaudout Wave Ripon Management Mo•AW Codesha..cedes far faaardous wash beabrenL deposal,and recymng systems) <br /> 1 28 Desg,ul d fad ry0afaro Oppro p CB e1W6pn d xyp d h ra duos maMda!s m erect Ey sM mandsl a up at netl,n be n lea -- <br /> RinMdRypedName 6gnawrs Monm Day Yeas <br /> 74v � <br /> EPA Fam 6700.22(Rea.3-05) Praaioue millmillare obsolete. co 130 <br /> - DESIt3NATEFfFAGIL-IFYT'ODESTINATION-6TATE(IFREQUIRED'-- <br />