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Please print or hype.(Form designed for use on elite(12-pitch)typewr ter.) Form Approved,OMB No.2050-9039 <br /> UNIFORIA HAZARDOUS I•Genoa e5-lD Number 12.Pagelof 3.Erergerq Response Phwc 4.Manifest Traevog Number pp <br /> WASTE fiIANIFEST CAL000182604 209.662-4908 a 02829095 G B F <br /> 5.Generators Name and MaungAddress Ge;wm'DrsSiteA'c.d,s55(Ad ferenithanrrkUmga4dfcss) <br /> PREMIER FINISHING <br /> 7910 S LONGE ST. <br /> STOCKTON,CA 95206 <br /> Generdtars F'hor'�+3: 209-982-5585 <br /> 5.Trans cdcr I Coraparry Name U.S.EPA ID Number <br /> AiIERICAN VALLEY WASTE OIL,INC. CAL000827878 <br /> 7.Trar�sporler 2 Company Nzme U.S.EPA ID Nrsnber <br /> 21st Century Environmental Management of California LP CAR000210617 <br /> 6.Designated Fadiy Name and S�teAdsirc�s <br /> 21ST CENTURY ENVIRONMENTAL MGMT OF NEVADA,LLC U.S.EPA 14 Number <br /> 2005 NEVWL.ANDS Da.EAST NV0980895338 <br /> FERNLEY,NV 89408 <br /> Faa:itys Ph�na: 7755-575-2760 <br /> 9a. <br /> a.U.S.DOT Desaip an Name.Hazan3 Glass,ID Numbef, 10.Conta finers 1 i.Total Q.Urct 13.5'ras e fades <br /> HM acd Paclong Grap(�fany)t No. Type Quantity lvw,;. <br /> 5-x 1. RQ,UN1325 WASTE FLAMMABLE SOLIDS,ORGANIC,N.O.S.A.1 DM 7817 P D04 1 352 <br /> ACETONE <br /> LU <br /> 2. RQ,UN1993 WASTE FLAMMABLE LIQUIDS,N.O.S.,3,PGII 3 DM 165 G D001 F003 214 <br /> ca ACETONE PAINT <br /> 3. <br /> 4- -1-- F I <br /> 14,Special FlatuIlcrg lmtru i'ns and AGd conal Iri!m ation <br /> 9b-1 PROF)LE#709848-00,ACETONE RAGS,ERG#133 `1`!� � � <br /> Ob-2 PROFILE#648076-01,ACETONE PAINT,ERG#128 CONTACT; V <br /> - q Q665 <br /> 15. GENERAXOR'VOWEROR'S CERTIFICATION:Ibereby"ethat Mecontents dVis Gor>,s nmemare fL" and awm3telydesaucda-,vmbythe popershJppuwgMarie,amare da55iv,padc3aw. <br /> marked and labekd'placarded,and are in all resNcts in proporoondlion fortanspai acoordmg to applicaNe lnlemavonal and nationalgovammeclal rc-(yh.ions.If export W menl and I am the Prxnary <br /> Exporter.I oE�rt that the confers of tfs crx6gr-ml mLVm to the te=of Ore attaeed EPAAdToMedgmenl of Current. <br /> cerLly that the waste r5- J7 Son statement idcnb.W in 40 CFR 252.27(a)(d I am a Largeq',raotity gerrorator (b)(61 am a n5-sartfygenera!Cr)is <br /> Genera;o?sfoffero5Print plNanle Sgna[Ur Mon r Day Yrar <br /> � 16.fntemalional Shipm�: <br /> a— ❑Import to U.S. ❑Exf. iron U.S. Porta entrylexiL <br /> Trarcoorier signature(fur exporls only)= Da;e le3vvrg U.S_ <br /> L= 17.TnnsprxlerAclmried✓mentofRece;ptof7,faterWs <br /> TrarsporWn i Pdntedlr Nacre Signature Mm:h Day Year <br /> Trar xwr ame SIc,na e Month Day Year <br /> UN <br /> 13.Discreparcy <br /> 15a,Dscreparwf Indl at%7nSpace ❑ Da-* ❑Type ❑Resides ❑Partial R*diann ❑Full Rejectim <br /> IAarafest.Ra'erence N.-bar. <br /> 18b.AhemveFadiy(vCzc ,.or) U.S.EPA ID Number <br /> =r ' <br /> U <br /> LL Far3�ttY5 r'N�' <br /> fAc Sgriawre &0'xth Day Year <br /> d <br /> 2 <br /> I R.Hazardous Wasto Repot Management h!ethod Codes(i.e.,codes farhazardous waste Lwlmea% and mt}+:�vg systems} <br /> LU <br /> o <br /> 20.Designated Facwly OATxr or Opemlx Cert3cat;on of rem4pt othazardous rva covered by the marZW v=pl as odsd in Item 183 <br /> print—lig SignatutsWcnth Day Year <br /> &�R 1 <br /> 10191 1115 <br /> EPA norm 8700-22( ev.3-95) Previous editions are abso!ete. <br /> OCT Z 12015 DESIGNATED FACILITYTO DESTINATION STATE(IF REQUIRED) <br />