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Please print or".(Form designed for use on elite(*0ich)typewriter.) L) `f Form Approved.OMB hro.205t}0039 <br /> [1NIFOR�hIANIFEST <br /> HAZARDOUS1.Generator ID Number 2.Page 1 of 3.EmzrgencyRespmse Ptgnc ¢7danit OTOm�t0 e G B F <br /> WASTCAL000182604 209-662.4W8 5 <br /> S.GeoPratorsNaraandraa7ngAddress Generalo�sSileAddress(dds`ferentthannra'-Tirgaddress} <br /> PREMIER FINISHING <br /> 7910 S LONGE ST. <br /> STOCKTON,CA 95206 <br /> Generators Pha>a: 209-982-5585 U.s.P.PAIo Number <br /> 6.Transpatcr i CoraparryNamo <br /> AMERICAN VALLEY WASTE OIL.INC. CAL000827878 <br /> 7.Tmrsslorler2 Carrpairy Name <br /> U.S.EPAID Number <br /> 21st Century 1=rwirownent3lManagement of California LP CAR000210517 <br /> 8.DeskJrratW Fad4 Name and Site Address U.S.PPA ID Number <br /> 21ST CENTURY EMIIRONMENTAL MGMTOF NEVADA,LLC NVD380895338 <br /> 2095 NEWLANDS DR.EAST <br /> FERNLEY,NV 89408 <br /> Fates Plxxw: 775-575-2763 <br /> 9a. .� ,E)<7T r ;fig Prower sr�pp ry Name.t Class,ID Numae s o.cerva 11.To*ol 12.Mt <br /> Quanti 13.vrastacodes <br /> pa,l and F'acldng Grvvp(rr amr}} <br /> No. Type ty 1h'tNa1, <br /> r 1' RQ,UN1325 WASTE FLAMMABLE SOLIDS,ORGANIC,NA,S.,4.1 DM 760 P DOO 1 352 <br /> ACETONE <br /> 2. RQ,UN1993 WASTE FLAMMABLE LIQUIDS,N.O.S.,3,PGII 3 DM 165 G D001 F003 214 <br /> ACETONE PAINT <br /> 3. <br /> 4. <br /> 14.SpC6A Hx4k1g InSfredi7 t5 andA Sd anal tnfurnaUom <br /> 9Ir1 PROFILE#709648-00,ACETONE RAGS,ERG#133 I <br /> D <br /> 9tr2 PROFILE#&48076-01,ACETONE PAINT.ERG#128 CONTACT (D � I� <br /> 15. GENERATOR'51OFFEROR'SCERnFICATION:fherebydedaethat&contents ofUu5tor*nmedare luDyandamim desaibedabovebyfhaprWersWpp;gname,andararlassilied,pa.zgod, <br /> marked and labeledrplacarded,and are in A respects in"roondtim fortranspori according to applicablelniamabonaland national governmental regulaSons.If ezpA shipment and I am rhe Primary <br /> Exporter,I certrytlmUhe conteresof Iles consignvr�nt rAnbmn to the teums of the atadred EPi%Aduno+aSedywt of Cocvsmi. <br /> cerz y that the waste mWmtiabm statement ilenWied in 40 CFR 2b'2.27(a)(d I am a rave waotAy (b)fdl am a granny genreralor)Is <br /> GenemtorslOfferorsPsfnl Name Sgnalur MOM Day Year <br /> 1 JV1 /c� 16 � <br /> 16.lnterrational Sh pix ❑Import to U.S. ❑Ew from U.S. Pat of emtgfcr <br /> Transpoi-10 ag-une(feroapatsonly): Date leavingU.S_ <br /> 17.TramperlerAdmm$edgment of Reo*of eta wWs <br /> ILI <br /> 12 Transaic+ <br /> pl PrkntedlT Name Signave MomUa Day Your <br /> O <br /> Q <br /> w Year <br /> :z_1 Tra. er P' oma Signa e ti bfonlh Day <br /> G DO <br /> 18.Discrepancy <br /> 18a,Discrepancy In6cation Space ❑ On-ly ❑Tpe ❑Residue ❑Perlia!Rejector ❑Fu>I Rejector <br /> rAarafest Re!erenco Nrr.�ber: <br /> 18b.Ahumate Fadrity(or Gennrator) U.S.EPA ID Nurmber <br /> U <br /> Fac5ty's Phone: fdornth Day Year <br /> 18�Sty ra4r a of{Utem'ile F&Oy for Gemma) <br /> Q <br /> z <br /> 14.Hazardous 1Nasle Report Wriagemunt Methal Cedes(.e.,odes for hazardous erase treatmer�dsposaF,and rutiydmg systems) <br /> A 1. � � 2. T-Ti f 3. 4. <br /> 20.Designated!ec ty O nen or Operator:CatScatior of receipt of hazardous materaa.4rrf coaled by the mantled e=pt as ndA in[,,em 18a <br /> F inI d T S � MonVl Gay Year <br /> L)l 115 <br /> LEPA Form 8700.22{ iv.3-05) Previous editions are obsoete. <br /> 0 C T Z 12915 DESIGNATED'FACILI'IYTO DESTINATION STATE(IF REQUIRED) <br />