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State of California—Environmental Protection Agency See Instructions on back Of p 6. Form Approved OMB No. 2050-0039 (Expires 9-30-99) PI t tye Form designed for use on elite (12 -pitch) typ er. Deportment of Toxic Substances Control Sacramento, California ease pnn or p - 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas (A.Generator FORM HAZARDOUS `` is not required by Federal law. WASTE MANIFEST -' t °f or's Name and Mailing Address �r `,^,,Wj` ,/^s„li�.` A. State Manifest Document Number 4qW101 UJQ TC` e�ai,,.,J4,�Y'.. B. State Generator's ID ft rQ 's Phone (_. ).prter 1 Company Name 6. US EPA ID Number C. State Transporter's ID [Reserved.] A10FRMAN VALLPf WASTE Olfh I j D. Transporter's Phone 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID [Reserved.] F. Transporter's Phone 9 D si nQ�e Fa4i �ityRmg a it �fg� 10. US EPA ID Number G. State Facility's ID I�iA9tt i.l#. tliia'Yf I3 GURUS D H. Facility's Phone R ANK. CA 96367 1 12. Containers 13. Total 14. Unit 11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) No. Type Quantity Wt/Vol I. Waste Number State a I N"'f!WRA HAZARWU8 WNAS T k L.10010 G (OILY WATER) "f....„ EPA/Other i M E b State E EPA/Other R A c State t T O EPA/Other R State i d. i EPA/Other -^ s sc K. Handling Codes for Wastes Listed Above J. Additional Descriptions for Materials Listed Above 't ''" "TNJs s. T " �Y1.- g 6. > i,f1.� �+t� t.►t�� e. d. 5 15. Special Noodling Instructions and Additional Information GLOVES EMEAGENOY PHONE 2009-667-8857 C 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, packed, Jmarked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. -�+ If I am a large quantity 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 economically i practicable and Yhot I have selected the racticable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health n p 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 available to me and that I can afford. D - Month Day Year >. Printed/T ped Name Signature .-^-- Z f ~T L T 17. Transporter 1 Acknowledgement of Receipt of Materials RSi nature Month Day Year w A Printed/Typed Name g �E SAA w 0 18. Trans orter 2 Tcknowledgemenf of Receipt of Materials O T Printed/Typed Name Signature J 1 ` J� Month Day Year LU E t' N R V19. Discrepancy Indication Space JUL 27 200 Z F — A CA I � L 20. Facili Owner or O erator Certification of recei t of hazardous materials covered b this manifest exce t as noted in Item 19. Printed/Typed Name' � Signature -..._...... Month �D.yYear DO NOT WRITE BELOW TH15 LiNt. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. (Generators who submit hazardous waste for transport out-of-state, DTSC 8022A (1/99) r4 a produce completed copy of this copy and send to DTSC within 30 days) EPA 8700-22 T wt DO NOT WRITE BELOW TH15 LiNt. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. (Generators who submit hazardous waste for transport out-of-state, DTSC 8022A (1/99) r4 a produce completed copy of this copy and send to DTSC within 30 days) EPA 8700-22 T wt