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Sw.of Colifornla—Envlronmemal Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-96) See Instructions on back of ! 6. DeparlmS ra Toxo S a«es Control I <br /> Naris print is type. Form designed for use on&life(12ptfch) iter. Sacromenro,Californiaali <br /> 1. Gerrntor's US EPA ID No. Manifest Document No. 2. Page 1 Inlormalion in the shaded areal <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST 161412141019111- 1 510 of <br /> 3. Generator's Name and Mailing Address state ManifestDocument oNumber. <br /> so <br /> ROBERT G. NOWFN <br /> 10 1003 Vienna Dr. , Lodi , CA 95242 R state Ge mratar.ID , <br /> ul A. c&rrMar',Phone2091 3 - 1-1-1•-1—�—� <br /> S. Tramporter 1 Company Name 6. US EPA ID Number C. Stale TromposrorF ID ' <br /> ao <br /> NOR CAL OIL D. Transpo ter i Phone <br /> Q7. Transporter 2 Company Name 8. US EPA ID Number E. Stole Transporfe�s ID <br /> U F..Transporter's Phone <br /> n 9. Designated Facility Name and SIM Address 10. US EPA ID Number G. State f«Jity's iD <br /> Z ' <br /> L1)z <br /> r-io AMERICLEAN, INC. <br /> O)! 2255770 Almond Dr. ."' Fadh '"h°°° <br /> ,t.n^ — S11 ver S rin s NV <br /> W and ID Number 12 Containers 13. Total IA. Unit <br /> Z I1. US DOT Description(including proper Shipping Nome,Hazard Class, ) No Tvw Quantity Wt/Vol 1. Waste Number J <br /> a' NON-RCRA HAZARDOUS WASTE LIQUID 51ae 23 <br /> aG (WATER A OIL) D D EPA/ORur <br /> E <br /> N b. Stora <br /> E <br /> tV R EPA/Ofwr. I <br /> A <br /> � T x smro I <br /> O EPA/Other <br /> R <br /> w <br /> Z d Sate <br /> w <br /> U EPA/Other <br /> w <br /> Z <br /> O J. Additional Descriptions for MaterialsListed Above K. Handling Codes for Wastes listed Above <br /> CL TANK BOTTOM WASTE b. <br /> lr RINSATE <br /> C. d. <br /> Z <br /> O 15. Special Handling Instructions and Additional Information <br /> a APPROPRIATE PROTECTIVE CLOTHING site: 251 Ticknor Ct. , Lodi , CA <br /> Z <br /> "EMERGENCY CONTACT: (209) 667-6692" <br /> SEE E.R.G. PAGE 31 <br /> —s 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the coments of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> J <br /> Upocked,marked,and labeled,and are in all respects in proper condition for hansporf by highway according to applicable iMematiorl and national government regulations. <br /> If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> neconomically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available tome which minimizes the prcserd and furore <br /> N threat to human health and the environments OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available ro me and that I can afford. <br /> yO Printed/Typed Name Richard Thorpe agent for 3'9^°"'" ) Month Day Year <br /> V <br /> Z 1 17. Transporter 1 Acknewled ement of Recei f of Materials <br /> 0 A Printed/Typed Name RXXXXRMXx Sifilnk NX Nle Signature fit? Month Day Year <br /> I A Is <br /> 0 18. Transporter 2 Acknowled ernent of ecei t of Materia <br /> w T Printed/Typed Name Signature Month Day Year <br /> O it <br /> ywj 19. Discrepancy Indication Space <br /> F <br /> A <br /> Z c <br /> 1 <br /> L <br /> l 20. Facili <br /> hum <br /> Owner or rotor CerliflcaSon of receipt of hazardous materials covered b this manifest except«noted F Ram IR <br /> T Pditted/Typed Name SigrMonth Dal' Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/95( Yellow! GENERATOR RETAINS <br /> EPA 6700-22 <br /> n•v <br />