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SO-r f Califomio--Environmental Protection Agency j � <br /> Form Approved OMS No,2050-0039(Expires 9-30.96) � - See InstrNctriorls on back ty yr ge 6. <br /> Please print or rype. Form designed lar s,w en eGRr(lSp+rch}iys,erriMi { - ''- 0"Partrnent of Toxic Substances Contrd <br /> Sacramento,California <br /> UNIFORM HAZARDOUS <br /> I. Generator's V5 EPA ID No., Manifest Document No. 2, Page 1 Information in the shaded ore ss <br /> WASTE MANIFEST �! 1J r ! fI I I is not required by Federal law. <br /> { of <br /> 3. Generator's Name and Moiiinq Address 5fati 'bei <br /> N <br /> h <br /> A. Generator's Phare / )e'J a �C6 s j��,/t A,,. <br /> p �f <br /> O 5. Transporter 1 Company Name 6. VS EPA Ip Number <br /> C? <br /> i! 11laq <br /> AMERICAN VALLEY WAS'"E. OIL INC 1CWL10j0101-8121718 78 <br /> —` 7. Transporter 2 Company Name 8. US EPA ID Number <br /> U <br /> 7 <br /> 1 Q <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> 1 TND€]STHi `L SERVICE 011' CO 14C <br />' 0 17 0 u 3. SJ'I'G Sm <br /> J a 1rOS ANGELES t CA 90025. C A D 0 ° 9 u 5 21710 <br /> 1V _ <br /> ` Z 11. US DOT Description(including Proper Shipping Nome,Nazord Class,and ID Number) 12. Cwtainers 13. Total 14. Unit <br /> No. TVP. Quo" � Wt/Vol rite <br /> 7 a' NON RCRA HAZARDOUS VASTE. LIQUID � <br /> 3 G: { 01"LY WATER } 0 T -i G a <br /> 04 <br /> ro E <br /> b. f ; <br /> v <br /> C4 R <br /> A <br /> co <br /> OLU <br /> Fe <br /> -z d.LU <br /> LLI <br /> .z R,i;ar t <br /> 0 <br /> W' - <br /> a - ,d <br /> Z . _ <br /> O 15. Special Handling Instructions and Additional Information <br /> Z GLOVES <br /> W <br /> EMERGENCY PHONE 209-057-�d57 <br /> ' <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, I, <br /> U packed,marked,and labeled,and aro in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantity generator,I certify that I hares a program in place to reduce the volume,and toxicity of waste generated to the degree [_have deherniined to be <br /> J <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the presort and future <br /> threat to human health and the environment;OR, if 1 am a small qucn*gener ,. r,I have made a good foA effort to minimize my waste generation and select the best <br /> waste mane ement method that is available to me and that 1 can afford, <br /> Printed/Ty Name Signaturo JNorltkt <br /> 17. 7ra5t rher 1 Acknowled f1/n I I <br /> LLJ Receipt of Materials- <br /> C7 A Prints /Typed amt Signature j om►� } <br /> P <br /> yy 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed Name Signotu . Month. Day. Year <br /> 0 E . <br /> V)i) 19. D scrapancy Indication Space <br /> f <br /> Q F - - - - <br /> U A <br /> z C <br /> 1 20, Facility Owner or Operator Certification of recei t of hazardous materials covered by this manifest exce t as noted in Item 19., " <br /> T Printed/Typed Name Signatures hlorrfls m- 'Year <br /> Y <br /> Day.':' <br /> '' <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC W22A (1/9.7 <br /> EPA 8700-22 Ye[law: GENERATOR RETAINS <br />