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Stale of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of page 6. Deportment of Toxic Substances Control <br /> Please print or dype. Form designed For use on elite(12-pitch)typ -iter. Sacramento,California <br /> P3. Generator's <br /> NIFORM HAZARDOUS 1.. ,rotor's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST4 1 __J1 <br /> . of is net required by Federal law. <br /> ' Name and Mailing Address ` AVVV- State Moriifest Document Number <br /> O �rj (, �f v C B. State Generator's ID <br /> 'W) A. Generator's Phone r— 1,g ' r 1, i �� - v,�Lr <br /> (V 5. Transporter l Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> sn <br /> C? AMi;.Ri4,if°SN tlAi,.4.,E[ WASTE 'OiL tom, > L 10 0 0 9 2 7. 1 orters <br /> P. <br /> D. Trans Phana <br /> 00 { 1 . <br /> ' 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> QF. Transporter's Phone <br /> V 10. US EPA ID Number G. Slat 'ci '�.:3D <br /> ��i� Ld�'{'����'�.°T �i' r I� .F� 0 Vis': 1 . <br /> Q <br /> ae H. Facility's Phone _ - <br /> 3 0 RI VIC;RVANK, CA 95367 C A 09 3 81:61 <br /> V11, US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number( 12. Containers 13. Total 14. Unit <br /> IL <br /> �-y y y �y t :C� No. Type Quantity Wt/V.1 I. Waste Number <br /> WAJ <br /> ~ t OILY WAIV,1 s1 0 0 � ask i <br /> G � EPA/Other <br /> 13 <br /> ci E <br /> o N b. <br /> State <br /> 00 E <br /> 1R EPA/Other <br /> � A <br /> O T c. <br /> Stale ..- <br /> co O <br /> R EPA/Other <br /> LL <br /> 's" d• State <br /> r <br /> Z <br /> U EPA/Other <br /> ' J. Additional Descriptions for Materials Listed.Above [ K Handling Codes.For Wastes Listed Above <br /> t. <br /> (AL,YWATER # o rf b' <br /> sn <br /> LU <br /> C,' d. - <br /> Z 15. 5pecial Handling Instructions and Additional Information <br /> H <br /> Z rN,.0 Vr3 <br /> ,,, �:�1iEROC!�JCY P��+s N 200 4:.18740.1 T <br /> t�- <br /> Q16. 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,packed, <br /> V marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J <br /> If I am a large quontiy 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 eco nomica11 <br /> CL practicable and that I hove selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> M 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 best waste management method that is <br /> ae available to me and that I can afford. <br /> l O} Printed/Typed Name Signature` �;l _4r`NN Month Dtrys. ✓Year' <br /> i C' `� - <br /> LLA B 17. Transporter 1 Acknowled ement of Receipt of Materials <br /> LU p Prints <br /> ,i/T?'ped Name, Signature /` J�r Month Ray Year <br /> $ <br /> Li 0 18. Transporter 2 Acknowledgement of Re6i t of Materials <br /> 0 Printed/Typed Name Signature Month Day Year <br /> LU E <br /> '< R <br /> V 19, Discrepancy Indication Space <br /> z F <br /> — A <br /> C <br /> 1L 20 0— . F cility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item f 9, <br /> Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE, <br /> ' DISC 8022A (1/991 Yellow; GENERATOR RETAINS <br /> EPA 8700-22 <br />