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State of California—Environmental Protection Agency <br />' form Approved OMB No 2050-0039(Expires 9 30 49) See Instructions on back of pa'qP 6 Department of Toxic Substances Control <br /> Please print or type Form designed ler use on elite(12 pitch)typ Sacramento California <br /> LFI (. alor s US EPA ID No Manifest Document No 2 Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS r r� <br /> WASTE MANIFEST -IRUQ { F is not required by Federal law <br /> /J {� ' 1 Of <br /> 3 Goneralor s Name and MoilingAddress Q( � C <br /> � {/` �1 �j A S,t�aie?�lctnr�es�f�DocJ n Jitmber <br /> 1 /�'�j1\41 lJ� \ ]s-F, • st b x JJs (r rrSs' t VyW§ � s <br /> () ,�t�11 / aC L`J' fS�,StofeGayeavt0`c,slD�t��-'^�c sr � s�.¢yP,� <br /> �� Lcg� Cr ,V t/r �' /V ^ il h >�� , <br /> h d Generator s Phone ��/ <br /> C14 5 Transporter 1 Company Name 6 US EPA ID Number C"Ir SldfeMTigr<".��qr of, IkD ese'ri k!)y "6 �*' <br /> AMCRIGAN VALLEY WASTE OIL � AlL 01010113 `�' <br /> 0o <br /> 7 Trans artar 2 Company Name 8 US EPA ID Number <br /> .-- P tF v SfafB Tr ifslt8rt"er's"�TgiERese7ve �� <br /> n <br /> —r _2'"�k -sr' <br /> V 9 Do-s n led ac h Name and Site Address 10 US EPA ID Number Cyrx$tafq Fd t{j fs ID + <br /> Q RIg9i4'd i��'OII I-RANSF"Ef� 3 k � <br /> Z <br /> t oC 5300 ls 'rGLAU UAO l` f <br /> 'X <br /> yr•'1?"1 KIM€��ClirEROANK OA 95,367 C AL `I O fl D 9 0 �y�� <br /> Q 11 US DOT Description(including Proper Shipping Name Hazard Class,and In Number) 12 Containers 13 Total ld Unit �F <br /> Z No Type- Quant Wt/Vol �ly Vsasle9j <br /> 'h <br /> = NODI-RCfiA HAZARDOUS WASTE LIQUID <br /> 3 c, <br /> (OILY WATER r € 0 9 T r � EP4/sOiher' r� ' �Nco '�ivx 501* <br /> c3 N <br /> co <br /> N R :�P'A �lther `Ta <br /> I tt A <br /> S 1'ty j <br /> o T c Sft�pisu fi y <br /> ao O � <br /> �rE�A/3tfior�F "r <br /> w d <br /> ,5ld1 ss s� < <br /> U ryEPA�OT egQ iav � 3 <br /> s �Addttoh"al bgiirifitfn�rs'f$ v5��eIdls�li ted A�oJo ,t " n a i° r x s r 9 <br /> d�e� o� ase` id)b yLU <br /> /S�d esy,, a � r <br /> u r` Rr r G <br /> M� <br /> t ,c�'��❑1, ,�Or��� i"�� .� X71 *"'r�� a '� a� g,,, '� '�,q�y t�' �ia� ,� °u�-y`" �'�`, ,�i� �a�`�r �j'�'�� � <br /> §6"P <br /> Y�r3.n O4 <br /> e7 <br /> u nkb�F <br /> T' 'jp l td�hb'o- .a �> A,I { �`x4# ` .14*- <br /> 1 15}Speual Hondling instructions and Adddtonal Information <br /> Z Cit.O V t-'i <br /> W EMERC,ENC✓Y PHONE 209-667-8857 <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 /> U marked and labeled,and are in all respects In proper condition for transport by highway according to applicable international and national government reguloTfons <br /> J <br /> d I am a largequontry generator I certify that I have a proggram in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically <br /> practicable and that!have seleUed Ike practicable method of treatment storage or disposal currently available to me which minimizes the present and future threat to human health <br /> 0 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 Ike best waste management method that is <br /> available to me and that I can afford <br /> VPrinted/Typed NameySignature I Monik 'yDay Yea <br /> 0 T 17 Trans <br /> I Z , -'7 - <br /> otter 1 Acknowledgement of Receipt of Materials <br /> (.7 <br /> Iw P <br /> P18 <br /> d/T� d Nama , Y-Z Sign <br /> e f - 1 Month,, Day Year <br /> r ✓ W <br /> OR Trans ower 2 Acknowled ement o Racer t of aterials J� <br /> E Primed/Typed Name Signature Month Day Year <br /> ts.s / <br /> g r i' <br />' 19 Discrepancy Indication Space <br /> r <br /> A <br /> C <br /> I <br /> I f 20 facility Owner or O erotor Certification of receipt of hazardous materials covered b this manifest except as noted in item 19 <br /> T Prmted/Typed Name Signature Month Day Year <br /> 1Y <br /> 71 <br />' DO NOT WRITE BELOW THIS LINE <br /> DTSC 8022A 11/991 <br /> EPA 8700-22 Yellow GENERATOR RETAINS <br /> I <br />