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117— A- A o1;fo 149 . if'h i <br />Fnrm Annrovpd- OMB No: 2050-4039 <br />J A146RI01 [1ARDrjtj8 <br />1. Generator ID Number <br />2 -page I of <br />3. Emergency Response Phonp <br />4. ManildstTrackind NumberZP <br />G BF <br />17'{JVASTEWANIFEST <br />Gg. <br />MefreratbrR#d'Kdffr 'ess (if different than mailing address) <br />Generator Nameand <br />�--. <br />.. <br />N N ST, <br />1 Company Namo <br />-RK-3411 VALLEY WAST OIL, Will, - <br />U.S. EPA 10 NO We <br />8fit-JocIf . 0L8 Sk.OLALT . Y, <br />ilf, 'U.8i EPA ID Number <br />I <br />Rw1ummm SVCS <br />kwELL 61-REET <br />ga <br />9b. U S. DOT Destriptiom (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12, Unit <br />13. Waste Codes <br />No. <br />Type <br />}ilvtand <br />Nc*l(ing Group (if an <br />Quantity <br />ynwol. <br />Rr <br />D, ViA I C�9:� VV[k, -F- RJ�l j <br />OLE LIQUIDS, i-1.0,,�;., Pil�,�Ifl <br />ACE'S r rlAli' i <br />D M. <br />I <br />F r! <br />;u r: <br />yocial Handling ftthidtfohs and Addt!o..naI.Infqrmgt1ou <br />FIKOFILE&71295'801 ikm'Ta4Lz & Pmrr r-RG1-; 428 <br />WEROSCY CONMOT: STEVE rA <br />15. OtNERATOWS/QFFE'ROIIV'SCERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, 'packaged, <br />jqqiked'and labeiled4facarded, and are In all respects in proper condition for transport according to applicable international and national goVernmental regulations. If export shipment and I am the Primary <br />Ex brier, I certify that Ilia contents of this consignment conform to the terms -of the attached EPAAcknowledgment of Consent, <br />, <br />R 262.27(a) (if I am a large quantity gqjnqratoi�) or <br />I.Ced #1 am a small,,qua,n fly gsn6rator) is trues <br />is . inlnl:f on statement Identified in 40 CFR ft I <br />te'. <br />road <br />-=.MQntfi 'Day Year <br />-7 il "7 <br />lnIJdrAat16mJI Shipments <br />1. 1 . 11 Import to U.S. El Export from U.S. Port of entry/exit: <br />"Z7"1.16. <br />,Transporter signature (for exports only): Date leaving U.S.: <br />0 <br />.17. Transporter Acknowledgment of Receipt of Materials <br />'IMP <br />Transportfir4,,Printed7. ad Name Month Day Year <br />n; - <br />Ar, '9. <br />Z <br />Tr 6 V6RPfInk4d7Tq0dNa ly MoRth Vay ke& <br />aAP Ig at re <br />piscigipawy <br />8a. DI's crepano a Partial Reje,ftm ❑0 Full Rejection <br />y.Inolc lion Space D ❑Residue <br />EJ Q,6ntIty' F1 Type E <br />Manifest *Reference Number: <br />A <br />�Ob Altemb U.S. EPA ID Number <br />pr@to <br />wpilttyllq Phcin <br />!o, <br />;18c: ZjI Flatule ofAffemafe_Facfllty.(orGene - - - - - - - - - - - - Month---- Day - --Year- <br />_bzWo6s WSM19. kep�rt Management hfethQ d Codes codes for hazardous waste treatment, disposal,' d recycling systems) <br />7T"70 <br />0 1 the manifest except As noted in Item 18a <br />,b��r or Operator. Certification of receipt of hazardous materials covered by a <br />ameS �onth� Day Year <br />PdhteVrry`p-ed-N'-- <br />3-05):Ptevious editi <br />pns are obsolete, <br />