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Aug 28 06 11:25a Julie Huber • 2 68-3880 p.24
<br /> State d Cdifcrnio-Enrimnm.ntd P.ratoetiw Agency See Instructions on back o ge 6. Deporimenl oFToxlc Sub,lana,Cannot
<br /> Form App:ar.d OMB No"20 (Expires 9.30.991 Socramenw.Cali aria
<br /> pleo,e pried o•yM. F.,7 designed for wean PW F12-pilch)ypewrtlar.
<br /> UNIFORM HAZARDOUS i. Geaeomar',US EPA ID Na. E
<br /> cumsnl No 2. Pogr I 6;..S.n in the shaded crew
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<br /> WASTE MANIFEST 1 7 4;14
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<br /> 2. Gamrala/a Nane and Moiling Addma, A. 5bb Marifem Document Number 2 3 7 8 9 7 2 9
<br /> AMERICAN VALLEY CP.O BOX 34-1B. Stare c.oerarar•,ID
<br /> WI 6. Gmerolah Phone I awl 732.484ti DELHI, CA 833.1 S
<br /> N S. Tranw.ner 1 Canpany Nane 6. US EPA ID Nua.6.. C. SMI.iran,poHer,ID IRP�rr_d.l
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<br /> m 0. Tron,paMi r Phone
<br /> o AMERICAN VALLEY VVAs-m OIL12,1 Al L' 010101 q 4 800-732-4645
<br /> CP 7. Tea eporl.r 2 Compony Nom. B. US EPA 10 Namber E. Stale TromporNr's IDI m94I
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<br /> "i V 9. Drwgnmed Focil ty Naand Site Address 10. U$EPA ID Nembw G. Stale Forliy'r ID
<br /> —d RIVERBANK OIL TRANSFER i q q C��l q 0181 11 q
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<br /> OO RIVERBANK CAIit5367 4 4
<br /> ryU o,d ID Number 12. Caataimn 13. Total la, Unit
<br /> 11. US OOT D...lph.(induding Proper Shippnsg Name,Hazard Ck,,, ) No. T Ps Ouantiw Wt/Val I. Waste Number
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<br /> V= a NON-RCRA HAZARDOUS WASTL LIQUID 291
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<br /> J. Addidoml Dee,ipfions Far Motedol,Usted Above < K. Nordling Codes for Watt.,U.Nd A6oro
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<br /> Z 15. Special Handling Irulrvclion,and Acdil...I lekrmation
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<br /> z GLOVES
<br /> W EMERGENCY PHONE 209-667-8857
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<br /> I6. OEhiMATOR'S CERTIFICATION: Ihereby dedore-hatthe wnNM,olteisconugnmgnt an fully and accurately described obese by proper shippng iwme and er.dassi'ied,pocked,
<br /> Vmodal,and kbel.d,and are in all,.,pact,in praper wndilion tan hompan y liighnoy acwrding a app 1,A1.inlernalional and naliow ir..nn—w r,,tictliae,-
<br /> -' IE I am a large quanlly germara,I cMify Ilwl I ham a program in place b re�jya dm,Axl.and raAciy of w mtv generator,to the degree I Mm determined to be wcnomically
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<br /> � and Ae.mirorenem�OR,iF I am a,mall q�uamiy generahap I haw mode a goad Faith dkrl b min'mim�y'' Hr g.nsralion andyled the bell.pate xnag.n.nt metMd chat i,
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<br /> O Print / ed a /� FgrwNrd Mangy /Ools.7 Y.or
<br /> w T 17. Trona rte,1 Adnarrled emeN of peri I of Mc141c1.
<br /> R Print d e ^ ! Signature Nes ha Da Yeo.
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<br /> C 0 8. Tmnsoctrrw 2 Acknow.sd omen)d Rewiol of Malertah
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<br /> DO NOT WRITE BELOW THIS UNE.
<br /> YuAo-: 1ST SENCS Tic ',.. '.0 3cl e .::.'ib' •:%Itnlh ATS
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<br /> DTSC B022A1/9fl -
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<br /> EPA 8700-22
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