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nmental Protection Agency <br /> so 20S0-0039(Expires 9 30 99[ See Instructions on back of page B Department of Toxic Substances Control <br />' form designed for use on elite f I2 pochf Ir—meter \} Sacramento California <br /> UNIFORM HAZARDOUS 1ti_ -rotor s US EPA ID No Manifest Document Nom n 2 Page 1 I Information in the shaded areas <br /> is not required by Federal law <br /> W STE MANIFEST Z, (p V S oft <br />' 3 Generaror's Name atld MoihnVddress r1 r s � l,,�� ��`A P� A Stale Manifest Document Number <br /> 21154430 1154430 <br /> s E 1 OU?Q 0 0 B State Generator s ID <br /> t <br /> in d Generator's Phone[ ] ;—a�C� RaZO <br /> P, <br /> N 5 Transporter 1 Compp y Name 6 US EPA ID Number C State Transporter'.1D(Reserved] q IV <br /> AMERICAN00000-1 <br /> VALLEY WA%fE OIL 8 x J S 7 8-6 Transporter'.Phone <br /> 0 <br /> ao7 Transporter 2 Company Nome 8 Us EPA ID Number E State Transporter s ID[Reserved] <br /> M F Transporter's Phone <br /> 10 US EPA ID Number G StotLLii ocAIL.D j a 0 $3 1 IR <br /> d rTit 1S T3 �r5 CJ! lTi7i �T_ HH <br /> 310 CLAUS ROAD H Facility s Phone <br /> O 41VERRANK,CA 95367 10 Bit 6 2(yj_ 63_8181 <br /> Q12 Containers 13 Total 14 Unit =� <br /> V 11 US DOT Description(including Proper Shipping Name Hazard Class and ID Number) No Type Quonhty Wt/Vol I Waste Number <br /> Z a NON-RCRA HAZARDOUS WAST[ i IC?iJtC� state 221 <br /> _ <br /> ( OILY 1A ATEH } 0 0 1 7 T G EPA/Other i <br /> Stale <br /> o N b <br /> m E EPA/Other <br /> v R <br />' C14A c State <br /> CIE) °O EPA/Olher <br /> ad State <br />' LU d <br /> Z s <br /> w EPA/Other <br /> J Additional Descriptions For Materials Listed Above K Handling Codes for Wastes Listed Above ;>' <br />' OILY WATER a F)I b <br /> o d <br /> r <br /> Q <br /> Z <br /> J 15 Special Handling Instructions and Additional Information <br /> Q <br /> CLOVES <br /> RNC/ 10NE!r- 2 1 437 CV � <br /> W <br /> J 16 G>NERATOA's CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately descr16ed[o6ove by proper shipping name and are classified,packed, <br /> ttL�JJiG marked,and labeled and are in all respects in proper condition for transport by highway according to applicable tnternahonal and national government regulations <br /> ' IF I am a largo quaalily generator I certify that I have a program in place to reduce the volume and toxicity of wails generated to the degree I have determined to be economically <br /> N practicable and that I have selected the practicable method of treatment storage or disposal currently available to me which minimizes the present and Future threat to human health <br /> and the environment,OR,if I am a small quantity generator I have made a good faith effort to minimize my waste generation and select the bell waste management method that is <br /> Oavailable to me and that I can afford " <br /> ' Printed/Typed Nome / SignatureI t' u Z " Month Day Year <br /> Z <br /> is t T 17 Transporter 1 Acknowledgement of Receipt of Materials r r <br /> � Month Day Year <br /> Prtnted/Typed Nome Signature <br /> O <br /> R 18 Transporter 2 Acknowledgement of Receipt of Materials �' <br /> Signature <br /> 1 Printed/Typed Name Month Day Year <br /> LU E <br /> ' sn R <br /> V 19 Discrepancy Indication Space <br /> z F <br /> A <br /> C <br /> I <br /> LI 20 Facile ty Owner or O orator Certification of receipt of hazardous materials covered 6y this manifest exce t as noted in Item 19 <br /> Y Printed/Typed Noms Signature Month Day Year <br /> � Y <br /> ' DO NOT WRITE BELOW THIS LINE <br /> ' DTSC 8022A [1/991 Yellow GENERATOR RETAINS <br /> EPA 8700-22 <br />