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Aug 28 06 11:18a Julie Huber 20c-608-3880 P.5 <br /> Stab as Celiferruo—Envirpnmenlal Protection Agency 0 <br /> Form Appmvd OMB INC. 9 Etpim9 I", �y SBen)nsttuctions on back of u9e b. Depacment of iaxi<Substances Control <br /> %ewe gbryilr�eTld' ."f"mM�i'xd+.en dIM 113-pikAl Q'p+'nMc Sonramwlo,California <br /> ,r, mrw nF. Ge.d e.US EPA ID No. Manifest Dacvment No, i. Paps I Inlarmalion in the shaded woo. <br /> UNIFOIjM HAZARDOUS i 7 $ 0 1 aw. <br /> WASTE MAFIIFEST <br /> 3. Gemmae,Name and Mailing Add. A.StateMvnisse Document Number <br /> AMERI CAN VALLEY WASTE OIL INC 24716597 <br /> P.O BOX 340 <br /> e'. State.G.P«olar,to <br /> u" 600 732-4645 DELHI, CA 95316 . <br /> ,N 5. Transporter l Canpc:q•Nome 6. US EPA 10,Number C. State Trcnspoa./r IDlRnervd.l . <br /> f',o AMERICAN VALLEY WASTE OIL C A 010 1 D. Transporl✓s Ph?, 800-732.4645 <br /> m 7.-Transporter 2 Company Name S. US EPA ID Number I- Stas,Trcos"oer'.ID keserrd.] <br /> �¢ P. Trawpartera phone <br /> 10. US EPA ID Naber G. Sso , 1 <br /> 5300 CLAUS ROAD H. Facilily's Phone <br /> RIVERBANK,CA 95367 C1 A III q 01 01 1101 209-863-8789 <br /> �Q <br /> If- US DOT De.crlp8an lincluding Prayer Shipping Nom.,Hazard Class,and ID Num6erl12. Contain.rs 13. Total 14. Unil ' <br /> �r No. <br /> TOuanNry Wt/Vol I.Wass,Number <br /> °' NON-RCRA HAZARDOUS WASTE LIQUID 5m. 221 <br /> 3 G ( USED OIL) 00 1 T T G EPA/Odor <br /> E <br /> N b. Slone <br /> m E <br /> EVA/olh.r . <br /> e <br /> e A <br /> o T <. stere <br /> 0 <br /> R EPA/Other, , <br /> Fd. I Sas, <br /> Z <br /> LY EPAJOIher � . <br /> tilEdpal Ml6rtptionl6F'F{g1Yl°lr:Listed Abvii C.. K.:Hpdbng fodesbr Wastea listed Abws • . <br /> USED OIL&WATER 01 b: <br /> N <br /> w <br /> Q is. SpesivlH.dIFng Instructions and Additional Inlarmstion - <br /> z GLOVES <br /> w EMERGENCY PHONE 208-66T-8867 <br /> x <br /> Q 16. GENERATC18'S CERTIFICATION: Ihereby declare shot ire ccotmh of this connenmanl are fully and accuatelY described clow by properniprirg name and we<Iw,iFld,packed, <br /> V marked,and labeled,and ore in all respec;in proper conclsom for transport by highway according b applicable inhmalional and nwionego eminent reguloliom. <br /> J IF I.m a fust.gs.rliy g.mrator,I rlifi•that I hove a p run in place se Idu<.tat whim.od toxidly of waste g Id m Ihs degroe have determined la 6e sonamical'r <br /> e- <br /> "no W.and that I hov.selected the prodic.61.method.of treatment,smrige diWo I currently availaNe to me which miJmizel she pn erand fulvn threat to h..heaV <br /> iF I am a smell uaNi emrolu,I have mode a ond lith erfart m minimize m orae. .naragen and,elect•he best»vee mono a am methd that is <br /> Ih..mironmenU <br /> aroilabi.to me and l can afford. <br /> y Printed/Ty a /, SgmNrs / Manlh 0 ser <br /> Z / i <br /> w 0. 77. T oa .r kn led amen of el /arult <br /> w M Printd/TY- Nam / Sigontaa Mont Day Year <br /> w 6 J. <br /> LL 0 18. runs c � cknowled omenta Rerni to to ah <br /> 8 Printed/Typed Name Signature <br /> Menlh Day year <br /> 1 <br /> w E I <br /> P I <br /> Ud 19. Dbuepancy Indication Space <br /> 2 P A <br /> C <br /> L <br /> 1 20. Fwili Owner w tarot Cer8fxa8on of r...i t al h ardon,elas,rids covered by this manifest e,ceptat noted in Is,m 19, <br /> T Printed/T4 Nam Signature 7 Mandl Day Year <br /> y 22 <br /> DO NOT WRIT BELOW THIS UNE. <br /> YAH.. TSDF 5ENDS -nl'. G.)'Y FO :,Erik ic:I Ci- +xll1. i ,.c"5 <br /> DTSC 8022A If/": "dviucc t'cca-nifrLl : I :: <br /> EPA 8700-22 _u i <br /> I <br />