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p <br /> Please print or type (Farm designed`or use on elite(12-pitch)lypewritec) <br /> NONHAZARDOUS 11 1 Genera€or ID Number 2.Pageof 3,Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST "Q' <br /> G=rwalor's Name and Mrailinn Address -�wSf1GIATEU TRACTOR SERVICE, M. Generator's Sift:Address(if different than mailing aduress) <br /> 1323 W CHARTERWAY <br /> SIOCKTON,C:A 95205 <br /> Ge.-F.ra;ors Phone:°=�3-4riti-:i 003-105 <br /> E.Transporter r Company Name ''4 U.S.EPA ID Number <br /> AMERICAN VALLEY WASTE OIL, lll`�C. ti�.Al"C1�1[]m187 b <br /> 7.Transporter 2 Company Name t U.S.EPA ID Number <br /> R-Desig^r::rd Facility Name and Slte Adcress 'Elld-RAMC I"IU`.;ORDOViA, LLC. U.S.EPA ID Numbar <br /> i 1855 WHITE ROCK RO. -'°.I1�it3�88d1E�3 <br /> RANCHO CORDOVA,CA 95742 <br /> 916-351 <br /> Fr;:l-:r's Pler}e: <br /> a, 97 U.S.CBCT Descripfion;including Prnper Shipping Name,Hazard Ciass.ID'Number. 1u.Container +,1.Total 12,Unit <br /> 1 HT; and PaC Group lif any)) No. Type Quantity WLNal. <br /> -q;1:i its, AEROSOLS.. 2.1 <br /> LPIVERSAL WASI-E <br /> r <br /> w <br /> u <br /> Lu <br /> (.7 <br /> 4 <br /> 3 SperiaLHandl�ng q�stru4tions a:1d AJdifionai Information <br /> i-Elti�p <br /> LRGti <br /> '•1- GENFRATOR'S CERTIFICATION: I r eri,fy the mat rials described above on lhls rnanifest are not suhjert to faderal regulotlnns for reporting proper d!sposal of Hazaraous Waste. <br /> ��enerFdar'siDfierc�c Printe(lTypad Name SignaµKE f• Month Day Year <br /> —a"5.Internatlitnai fihi�rnerls - ' <br /> E ❑Import to U.S. ❑Export from U.S. Por;of e :ry crit, <br /> Lar-spniier siyn�-;ure;for exports ur.ly(: Date leavuig U.S.: <br /> Q 1 C 1 c-i sgorlar Acknaaledgmenl of Receipt of hlateria's <br /> to _ <br /> 0_1Tr,ns;zuner ec rypadName S gratu-e �. rt' Month Day Year <br /> Trans,in�ier 7 PriredtTypp.d Nana Sicna;uro t �' Month flay Ye r <br /> 17,Dsscrrpancy <br /> z. <br /> 17a.Dssrepency lndlcatior Space rr <br /> L. I Quantity Ll Type _..,Residue ❑Partial Rejection Ll Full Refection <br /> Manifest Reference Number, <br /> h 17.7.Allernate>=eciliiy tar Generator) US-CPA ID Number <br /> tJ <br /> u` Fucl.WsPharie: <br /> 17c,Si9naburo ofAllerrate Facility(or Generators Month Day Year <br /> Uj <br /> La <br /> La <br /> G7Y <br /> S.L esu.raled Facillty Qrrrnhr ur Opertitor:Cerfi ation of receipt of materials covered by;re i resl except as noted in Item 173 <br /> PrinlodiTyped Noma Signature Month Day Year <br /> o-NHfth-C-C-11 <br /> 2-DESIGNATED FACILITY TO GENERATOR <br />