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i - <br /> Sias.of Corfarn,o--Env+ranmantef Agr+ay See Instructions an back of page 6- Department of Twuc Substances Contra <br /> Form Approved DMS No 2050-00 9 IE4'fG$0-70 991 Sopamento Coltforn+a <br /> Phase print or type Form designed lot vie 041ita l 12 pdM4esypqwEtL°f <br /> 1 ' Manifest Oecvmant Na 2 Page I In#armahan in the sfwoea areas <br /> p Cis not required by Federal law <br /> �lfN1FORM HAZARDOUS Gar+aralar0s US EPA ID Noo l.. of r <br /> WASTE MANIFEST 0 <br /> A State Mdntfnat tbcureentw <br /> Nafser 21653098 1 6 5 3 n 9t8 <br /> V <br /> 3 Genarolar s Nome and AIAddressU <br /> Po "ox 8 Slate Ganarvtors ID <br /> 77 � 31s <br /> 4 Genera 419 <br /> ar s Phone d h f <br /> 4 Us EPA ID Number C Slate iraesparter's 10 LReseread} <br /> (.t 5 Transporter 1 Company Name r _ <br />' 'n A (.. .� i► L rF r :9 D Transporter s Phone „S{,t•• <br /> o AIAL KkCAN VALLEY WA51 L OIL ` <br /> <0 7 Transporter 2 Company Name <br /> 8 US EPA ID Nusaber E 1State Troniparler s 1D[Reid 1 <br /> co <br /> Im <br /> F Transportst's Phone <br /> a " III9Ll9dIl4iND ��vaiAAi�f �S� 10 US FPA ID Number c stagy ItyL'IRS L U I t3 fi 1 <br /> m Q 5300 l�k AU1 ROAD H facilib,y AT-463-81 81 <br /> z 0 f1 i 0 <br /> 1% WVERIJANK, CA 95307 <br />' Q l2 Containers 10 Total 14 Und <br /> Q No T Qscimtity W VI I Wase Number <br /> V 1 1 U5 DOT Oescrtption Iinduding Proper Shipping Name Ha lard Clens and ID Number) Stake <br /> U e hIQN RCN14 I•tALAfxUOU3 W^ TIE LIQUID0 1 r T L EPA/(ytfsr <br />' { <br /> OILY WATER ) <br /> 3 c $tate <br /> E <br /> C14 N b EPA/Other <br /> } yr R5 _ <br /> A <br /> 1 O T cEPAJOIhsr <br /> Q <br /> CQ <br /> � R 5lm. <br /> i w Is EPA/Okber <br /> f Z <br /> W <br /> V <br /> K. Hondlsng Codas for Wastes Listed aw <br /> w �) X81 b <br /> II 1 Additional Deserypimns for Materials Listed Abase a f ']" <br /> z L7IL'iC MATER J <br /> 0 d <br /> w c <br /> ua <br /> a <br /> Z 45 Speaal Handling losiruchar+s and AddilicI$nformatiaa <br /> GLOVES <br /> [ z EMERGENCY PMONE 208-867-t3A57 , <br />' 1 S y or ship name avid a»ciossilied packed <br /> >— <br /> app 1 by`nighwray aecording to app+cable international and natsonat government regufal+ani <br /> � <br /> 16 GENERATOR'S CEIETIHCATIOH E fnere6y deters kfsot the contents of this cava nment are full and accuratd�described a 'e PraP P <br /> i in proper condition(vr Fran <br /> Umarked and labeled and are in all rnpec! P Pe <br />' J +n oca b r <br /> educe the volurns end los,crty.of�.asty generated to the dsgsaa I lhave determined ka b+ecanomrealt <br /> f I ons a large quanby generator 1 cantly ilia!I have a prag'aalpien! storage at d+sl Y'al currently avorfable to n+a which mrmmmsis the Present and future threes to livasan health <br /> I d practicable and that k 6bare salaesad The oradtrs,bie method ofF waste generation and salad the 6eai waaia managemani rtsalewd Ihos is <br /> ul and the emnranmeal OR if I am a small quantity gonarntar.1 hors muscle a geed forth eller!to minimize ohY <br /> evadable b me and that 1 cos aifard f I "I a <br /> Slgnoe J ,J 1 {� i�+ <br /> Q <br />' U h �T�°d�riJ�aJ <br /> * � t 17 Trans tar 1 pckrwwlad amara of Recei f of klatanals � � � IJ <br /> � � e d/! Na <br /> k t V <br />' 5 Month Day Yee <br /> L w P <br /> 18 Trans r!n 2 Acknowled emenl of Rocas t o{blateno s Signature <br /> Q PnniedlTyped Noma <br /> ' w E <br /> ' + Q I9 Discrepancy Indienlron Space <br /> V f <br /> Z A <br /> > C <br /> I <br /> l t Mantic Days Ye <br /> iiia man+fasf ecce t as noted+n Item 1 <br /> ' f 20 Fac+li Owner ar Q rater Carlihaahon of reeaat of hasordisus mal 11 covered r ✓ +1 <br /> ,� Signotura/' ' "-� <br /> T Prtnted/TrP No"h; //__�� <br /> Yf v <br /> ao NOT wRlrlr BEl.ow THis uE <br /> I <br /> DISC S022A I1/991 <br /> £PA 8700-22 <br />