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0 <br />Please pont a 7 �ce, roan desioned for use on elite 172 -Ditch) i D91VIn erl <br />10 <br />:nA Non Vili trWV s -0b) VreVWUS eaRMS ere ODSOlele. I <br />DESIGNATED FACILITYTD GENERAT( <br />t. Generai ID Number Page tot 3.Emargency Response Phone 4.1ilanifartTracMng Number <br />UNIFORM HAZARDOUS I <br />WASTE MANIFEST 1 002187588 G B F <br />S: Generabrs Nemo and Mglug Address GardAnalors Site Addresa-(if different Nan maeing address) <br />AMERICAN VALLEY WASTE Citi.., INC. <br />RO.. BOX 340 <br />ene2lots Phone. DELHI, CA 55355 <br />6. reneporer 7 U.S: EPA ID Number <br />7. Tranrpaner 2 Company Now US, EPA ID Number <br />8, Designated Facility Name and See Moral U.S. EPA ID Non -bar <br />DK-DIXON <br />131X1 CHEVi WAY !`:w ti)tirp:l 124.' <br />OIXON, CA 55021) <br />Fact $ Phone' , <br />9a. <br />9b. U.S. DOT Description (m hiding Proper Shippug Name, NazeN Gass, ID Number, <br />10. ConanON <br />To1ai <br />12. <br />HM <br />and Packing Group (e anyll <br />Gr <br />Ouantlry <br />vol, <br />WLNW. <br />13. Waste Codes <br />No. <br />Typo <br />oNl'NFRCRA <br />RAZARDOUS WASTE i <br />ri OIL MIXED 01i <br />w <br />UJ <br />2. <br />UJ <br />3. <br />c t <br />I <br />� <br />4 <br />i <br />I <br />I <br />14. Special Handling hsWCions and Addieaal m omaen <br />GLOVE,,, <br />. .�, .. <br />f'Cill}3LtM UA(1tSGt1E11 E:}dit:i{o"Y{:t`NlpIcj-a t,Vkz Fty i4i-li <br />15. 6ENERATOR'SIOFFEROR'S CERTIFICATION: 1.11erebydetlare that Ne contew el INa oaamantara IWy and accurately describotl above hY the proper shipping name, ervf are cassfisd, packaged. <br />M" aro ebelaaplacerded and are in as madil In proper condApn for trnspotW40al to apq'wehle Imematbnaland national gwermnenel regdawns, tf expon shipment and lam the Pnmary <br />Exporter, I Whey ilial the cowanls of Mc imrgrcnant cunfam to the ezms of bye allacred.EPA k noaiodgmant of Cone art <br />I Wruly Nat the waste mineMzetbn statement klantrad in 40 OFF 20UT(a) (R I am a large quea6lygenerdi or (b) (PI am small quantiry generator) is vue. <br />Geroraer'slOMm/a PnnkH'fYW Name naWre Month Day Year <br />.r <br />ZImpel <br />16. m6nardral Shipments <br />11 to U.S. ❑Eepaifionrus Portofentrylexlt <br />Transponer signature (for exports only) _ _..._._...__... <br />Dare leaving LLS <br />� <br />77. Translkder AdmpvlatlgmeM of Prompt of Adaleneb <br />Transporter 1 PrIdedi Name : Siglwbare ("`Gj Month Day. .Year <br />- <br />L1i <br />Transporier2 rk .. .. 's Lara", <br />- North Day Year <br />Od <br />... _. <br />f- <br />19. Disvapmxy ,. <br />l8a. Dlsaepancy'.ndWbon Spee El Gurniny EITYP. E) Residue ❑Partial Refection ❑Fill Rejection <br />Mamfesl Reference Number: <br />tab. Atemme Facially for Generator) U.S. EPA ID Number <br />U <br />ua. <br />Faolnys Phone'. <br />w <br />t&. Signature WNrerrate Featly (or Geraralor) <br />MooN Day Yea <br />y19. <br />riumnous Waste Report Management Method Codes (i.e., odder For hazardous waste veatman4 disposal. ark reeytling syrlams) <br />1. y <br />1 <br />2. —T- <br />.20. <br />20,Designaed Facility Owner or Operator CBNM3eIX1 of receipt of hazardous materials rovered try ve medleN evWgr as ntted an lam t i)a <br />Piantedi"ryped Name signali. �r"/ ,• MMN ey .ran <br />:nA Non Vili trWV s -0b) VreVWUS eaRMS ere ODSOlele. I <br />DESIGNATED FACILITYTD GENERAT( <br />