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EA�Customer EPA# <br /> Driver EPA#CAL 913534912 `/ Date: — I <br /> CHP#C 940 State Manifest Doc ment# <br /> I <br /> O <br /> S C A E T W ST IL INV ICE 10. 12 4 5 <br /> Wa • Sa ram r1tO, A 9 842 PA FRO THI IN ICE <br /> Transpo ars R gistrati n No: 130 (9 6) 84 -0 44 <br /> ext P/ Date: <br /> CO. ME <br /> ADD ESS <br /> CITY <br /> STA f ZI <br /> O DE CRI ION ICE T TAL <br /> Z Non- CRA azar ous aste quid. sed it/mi d oil. per <br /> 'No lacar requi d ( 21) gal <br /> Non- CRA azar ous aste iquid. sed nti-fr eze. /per <br /> "No lacar requi d ( 43) gal <br /> / er <br /> No lacer requi ed (2 3) ga <br /> OV13214 <br /> TO AL, -0- <br /> ESTI ATI0rRd <br /> IL <br /> o R.E. o DK ixon ❑Th mo FI Ids River ank Oil Transf r <br /> 151 S.Riv7 00 Che ton Wa 55 Sout Stanfo Way 53 0 Clau Rd. o <br /> est Sa ament1 xon,C 95620Spark ,NV 98 31 River ank,CA 95367 <br /> CA 044 0AT 080 12 602 NAV. 2 510 11 CA 00019 816U. <br /> rn <br /> m <br /> IMP TAI <br /> OTICI <br /> EGA DING T E DIS OSITI OF Y UR U D OIL.PLEAS SIGN FTER EADIN all <br /> Sac entaste me <br /> hereby dvises he gen rator th t your s ipment fused it may a trans orted t a facilit that is squired o comp y with f deral regula- <br /> tions pplicto mageme t of use oil,bu that is of requi d to c ply wi them re strip ant req irement applic ble to h zardou waste anagement <br /> facilit s.Crnia flities th t handl or pro ss use oil are squired to meet hose re strin ent req firemen s,and me ou of-state facilitie that process <br /> vsetl it alsset tha requi emenls.These i clude ore slri gent le k detec on and reventi n requi mems,engine ring ce fication of tank integrity,and <br /> finan ial asntesr closu and a cidenial release . It is la ul to s nd use oil too -of- a faciliti s that mply o ly with deral u ed oil anagement <br /> Stan rds not tha more strings requir ants. his poli cation i for in anon urpose only. <br /> GEN RATCERFICAT N: I h reby de tare th the co tents of his con ignore are full and a urately describ d abov by pro r Shipp ng name, <br /> are c assifackemarks ,labele and a in all r spects n prope conditi n for.lr. sport b highw y accor ing to a plicabl state a d feder I regulations. <br /> If I a a laruantigenera or, I ce ify that I have a rogram in pla to redu a the v lume a toxici of was gene ted to t e deg I have determined <br /> to b econally pticabl and th I have electedthe pre icable ethod f treat nt,sto ge,or isposal urrentl availabatome hich nimizes the <br /> pres nt anure that to h man he Ith and he envi onment OR,if I am a s all qua tity gen rator,I ave me e a go d faith ort to inimize y waste <br /> gen ted selece best waste anage ant met od that is avail ble to and th t can fiord.I ave no mixed ny of th waste ascribe above with <br /> any ther hdouseste,t e total elide co tent is ESS th n 1,000ppm,a tl the w Ste doe not co fain an PCBs. have c mplied ith the equirements <br /> of th applie Calrnia us d oil m nagem nt regul tions t determ a this i true. gree to ccept t e addit' nal ch rhes for the disp sal oft is waste if the <br /> infor ationve prided a out this w to i incorre t. I her y certi that all the info mation ubmitte in this nd all ched ocume is cont ins true and <br /> ac urate d criptio of the aste.Al r.;levan information <br /> Gene or's Si nature _ - re rding k own or uspect d haze s asso iated with <br /> the waste s been disclos d. I also certify t at I have not <br /> mi ed this aste wi h any o er was e.Venu for purposes <br /> Transp rter's ignatu e: of nforce ant she I be in crame o ou ty.I declare <br /> un er nArh that tt a foreg ing is t e and rrect. <br /> of <br /> T rm net 0 days. Financ charge 2% r mont (24% er year on act unts no paid wi hip 30 ys. <br /> A$25. 0 Fee ill be ch rged f return d chec <br />