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••• vonmemalrrolechonAgency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of Page 6. <br /> Pleci print or type. Form designed for use oa.tile 112-pikh) " writer. 9 Department of Toxic$gbstances Control <br /> Sacramento,California <br /> UNIFORM HAZARDOUS S .enerator's US EPA ID No. Manihst Document Nees 2. Page I Information in the shaded areas <br /> WASTE MANIFEST �/ EI �3 is not required by Federal law, <br /> t. <br /> 01010102 1 3 ii f3 6 0113. Generator's Nanta and Mailing Address A. State Manifest Document Number <br /> FON.FR'S AUTO F30DY V .6 Vh64^ <br /> h <br /> 4115N. E.CIiSi?N 57., tsl'CiC79�ICTClN, CA£15N203 B. Stale Generators ID <br /> A. Generator's Phone I �F(ICjI <br /> N 5. Transporter I Company Nome 6. US EPA ID Number p I_1 <br /> Jul C. State transporter's ID Rwervad. <br /> 00 <br /> D. Transporter's Phone <br /> else L Transporter 2 ompany Name E Number ? E. State Transporter's ID 1_ <br /> �U F. Transporter',Phan. <br /> ^ 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Slate Facility's ID <br /> O'^Oi AMERCLEAN, INC. <br /> WD 2430 ALFBION) DR. H. Facilites Phone <br /> �— `YLVEIZ 51MINGS, NV 89424 <br /> a/�� I1`Us DOT Description(including Proper Shipping Name,Hazard Class,and ID Number 12. Containers 13. Total 1 A. Unit <br /> V e V P I' B P pPinB 1 Na. T- <br /> 11. <br /> Type Quantity WI/Vol I. Waste Number <br /> Z a.WIN RCRA HAZARDOUS WASTE LIQUID <br /> = Smote <br /> 221 <br /> 3 V• (OR- A WAt F:R) EPA/Other <br /> N E <br /> O N b Stale <br /> m E <br /> < R EPA/Ofher <br /> v A <br /> O T Stale <br /> m O <br /> R EPA/Other <br /> as, <br /> ZdSisk Slate <br /> W <br /> U EPA/Other <br /> W <br /> Z1. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> 0 a. b. <br /> w <br /> w <br /> Z <br /> Z <br /> 0 15. Special Handling Instructions and Additional Information <br /> P: <br /> APPROPRIATE PROTECTIVE CLOTHING <br /> W °FME.RGFW:YCONTACT: (209)652-890[1" <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and occuralely described above by proper ship ing name and are classified,packed, <br /> Vmarked,and labeled,and ore in all respects in proper condition for transport by highway according to applicable international and notionaPgovernment regulations. <br /> J If I am a large quantiq generator,I certify that I have a pro ram in place to reduce the volume and mxi qqqi of to <br /> generated to the degree I have determined to be econamicollyy 1 <br /> CL practicable and that I have selected the racticable method of treatment,storage,or disposal currentlyailab1. o m.which minimizer the present and future threat to human heal M t <br /> and the environment;OR,if I am a small quantity generator,I have mode a good faith effort to minimi a my mls neralion and select Ike best waste management method that is <br /> vailoble to me nd that I can afford. r <br /> Z Printed/T .{`{apt. /17 -/% Signature _ J.lonlh Day I Lj <br /> l/ 1 <br /> W 1 17. Transporter 1 Acknowledgement of Ril of Materials <br /> at <br /> Printed/Typed Nome_ Signator.' oath Da Year <br /> IF <br /> S �' / 4 C� <br /> W 0 1 S. Transporter 2 Acknowledgement of Recei 1 of Materials <br /> 0 R Printed/T ed Nome <br /> W T yp i nalure Month Day Year <br /> W1 <br /> U19. Discrepancy indication Space <br /> Z F <br /> _ p <br /> C <br /> I <br /> L <br /> I 20. Facility Owner or O orator Certification of receipt of hazardous materials covered by This manifest except as noted in INm 19. <br /> T Printed/Typed Nam. Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: GENERATOR RETAINS <br />