Laserfiche WebLink
State of ColiFomia—Environmental Protection Agency <br /> Form Approvd OMB No.2050-0039(Expires 9-30-99) \./ See Instructions on back of Me 6. pe rim•ot of Took Substances Contra) <br /> Plea»print or yp•. Farm designed Rr vs•on giro(12-perch)"ewnhr. Pa <br /> Sacramento,California <br /> UNIFORM HAZARDOUS 1. Genernlars US EPA ID No. Manifest Document No. 2. Page I Information in the shade areas <br /> WASTE MANIFEST L Q110240161 a 5 O is mor rpai..d by Federal Rw. <br /> of � <br /> 3. Generators Nome and Moiling Address MCI <br /> I�� r ^��r A. StaN Mandml Document Number <br /> �yrst�q/`� py',c's�'{s`�y4 IeyyJl� /� �f 25162510 <br /> „ V`-'V `.: ad e 1 lJ L�V`-' B. Slats Generator s ID <br /> A. Generators Phan.XQ) 4 �' C <br /> N 5. Tronapanor I Company Nome 6. USE ID Number C. SMR Transporkrs ID IRgserved.I <br /> oa <br /> AMERICAN 61 LEY WASTE II D. Transporters Phone <br /> $ AM_. V..---• — — R _ .Ta aaa <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E State Lansponeh ID IRsserved.1 <br /> c'•I Q F. Transporter's Phots <br /> C\jDesignated Facili1,Name pad 5iro Address 10, US EPA ID Number G State Facility's ID <br /> CV Z RIVERBANK OIL TRANSFER 01811161 <br /> 5300 CLAUS ROAD H. Facility's Ph .. <br /> Ln Q I1. U5 DOT Description indulin Proper Shipping 12. Containers /3. Total ]A. unit <br /> N V P (including Per Aping Nam•,Hazard Class,and ID Number) No. T • Quantity Wt/Vol 1. Waste Number <br /> Z a. State <br /> ENON-RCRA HAZARDOUS WASTE LIQUID 224 <br /> 3 E (OILY WATER ) 0 0 T EPA/Other <br /> o N b. Stara <br /> co E <br /> Y R EPA/Oder <br /> a A <br /> o T Slat. <br /> m O <br /> R EPA/016., <br /> m _ — <br /> � d_ Stoll. <br /> Z <br /> w <br /> V FPA/OIMr <br /> W <br /> J. Additional Dern ptlons for Materials Listed Abow <br /> Z K. Handling Code.For Wastes Li,W Abws <br /> O OILY WATER 01 b <br /> w <br /> m e <br /> a <br /> Z <br /> O 15. Special Handling Imtruchoms and Additional Information <br /> Q <br /> Z GLOVES <br /> EMERGENCY PHONE 209-667-8857 <br /> Q 16. GENERATOR'S CERTIFICATION: Ih•reby declare that th•cam•ms of this comites nt are Fully and accurately described aboes by proper shiprirg name and are classified,packed, <br /> V ma.kd,and labeled,and are in all mspeds in proper condition For tmnsprn y highway according M app icable international and nations gwemmem regulations. <br /> J If I am a large q ontiy generator,I certify that I have o p oggram in place to reduce Ph.wl me and bsiciy f write gen d to the degree I have determined M be economical)yy <br /> y practicable and that I have elecrod the eradicable methodra{treatment, Mrage o dispo I currently available M me minimizes the present and future threat M human h.ohh <br /> and the environment;OR,ifsI am a small quantity generator,1 hws mode a goad faith effort M minimize my w chain ad select the best wmro management method that is <br /> ad <br /> O avail bls to an.and that I can afford. <br /> )_ Pries Ttaft6 Nam• OMonth DoY _ Year <br /> Z KIK_ 117T 2 <br /> R1 '17. Trans rler I Acknowld .m.nt of Receipt of Materials <br /> w N Printed/T Nama Signature Man1B— Day Year <br /> P <br /> Oe I8. Tran rhr2 Acknon,01mens of Racei toLMateriah <br /> Te Primed/Typed Nome Signature Month Day Year <br /> N F <br /> s ' <br /> w. Discrepancy Indication spat. <br /> Z P <br /> _ A <br /> C <br /> 1 y <br /> L <br /> 20. Facili Owner ar O tato,Curr i aeon of i t of hazardous materials covered by this mon) c t as now in Item 19. <br /> T Prince/Typed Na Signature Month Day Year <br /> .� g a o <br /> DO NOT RITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Bax 3000, 5acramenM, CA 95812 <br /> 6266 . 1575 <br />