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• • <br />Please Pbnt or type. (Form designed for use on elite 112-Mchl tvoeradter.l 17 viz n Zn c....., ..........r �„�„ <br />_PA Fon- 8700-22 (Re,. <br />are obsolete. <br />UNIFORM HAZARDOUS <br />1'wwawID Number <br />2 Page 1 of <br />3. Fmergauy Kepone Phoma <br />1. ManiMt Tracking Numbr <br />WASTE MANIFEST <br />CAD981675M <br />I 2DE <br />002363314 G B F <br />5. Generatd: Name arc MaJIN Address Gsw"s $36 Address (H ditwt than maing address) <br />SAN JOOAUIN REGIONAL TRANSIT <br />P.O BOX 201010 1533 LINDSAY <br />STOCKTON, CA 95201 <br />GeraramrsPtme. STOCKTON, CA 95202 <br />6. Transputer i Campany Name U.S. EPA ID Number <br />AMERICAN VALLEY WASTE OIL, INC. CALOW827878 <br />7. Trampaler 2 Compary Name U.S. EPA O Numha <br />Z%1 LP tj It. 17 <br />6. DaelpaMd FadNy Name Atldrea U.S. EPA d) Number <br />21ST CENTURY ENVIRONMENTAL MGMT OF NEVADA,LLC <br />2095 NEWLANDS DR. EAST NVD980895338 <br />FERNLEY, NV 89408 <br />Face es Ptme:775-575.2700 <br />ger <br />9b. U.S. DOT Desca"m (nclrairg PmW Shippiq Nan. Hazard Clan, ID Numher,10. <br />Ganteaera <br />11. Total12. <br />UnlitHM <br />ad Pewwn9 GLV (lf MY)) <br />Ouanery <br />YNfvtl. <br />13. Waea Coda <br />No. <br />Type <br />c <br />1. <br />NON-RCRA HAZARDOUS WASTE LKAJID <br />ANTIFREEZE SOLUTION) <br />G <br />--I"—'-i <br />.(BRINE <br />TP <br />() <br />� /� <br />2 T`rw - g644 AgA.0 kS WA41C L fA <br />cera <br />4dw4&^ <br />3. <br />---i <br />1. <br />14. Spa1M Kft t tnbm-aan <br />s�adaj <br />Qom, <br />7 f -QJ c j1 &n3v-., "AmhkaA..1/ <br />15. GENERATOR'SIOFFER n CFATIFICATION: I hereby declare the the mann ofthY mnpmare "hay and aavaaly daeabed ahwa by the Pmpershgpbg nrta, wd are dsaMed panoplied, <br />mated asci hbdedPemrdK ad as In all rappde in Pops undlnn fmbaneput accxduV to appicade ift a6malad <br />national gvwmentai mgda0ora. H ewwt shipment and I am da Rimy <br />Euler. osrlty oratM mnhna dSa mN¢rrare ocn/wm b ea lama dM attached EPAAdmwNedgm td Coneat <br />I T" as da pari melon sitaimd deaeed in 10 CFR 2MV(a) roI em p WW peaty ganalorrl or (b) (f I aha smal pumbiry gwwaar) is bus. <br />GarabnaaOlrnYa PflnadRyped tea. 9 <br />°ry <br />n/ R1G <br />,ver <br />S <br />F- <br />18. Imantional Ship ems <br />❑ Irrgorl to U.S ❑ Eodbwn U.S. Prt <br />z <br />d <br />TralloW wer"Allot <br />rda(ortworgy):Do* "U.& - <br />Owl <br />17. TwsMWAdmo%dgnd ofRw* d Malerhle <br />Sgatirp <br />dTranporar <br />`^ / Month Day Yea <br />/6/ <br />`•I <br />T 2 Pmtetlrtypa Name <br />Month Day Yea <br />�' <br />3 4 <br />16. Dlewepaay <br />18a Dhwepan y bNirattn Space ❑ Oua m, ❑Type ❑ Ra due ❑ Partial R*.W ❑ <br />Ful Reya t. <br />Manifest Referare Number: <br />18b. Nama F e�y (a Gernerater) U.S. EPA ID NmIWr <br />V <br />LL <br />fadihrs Phan: <br />saws <br />18c. SOatin ofAf mrwa FadNy(or Generate) Month D Year <br />� <br />Y <br />y19. <br />d <br />Haza " Waste Report Maam <br />gead nt MeCada ll.a., mdw for haaadwa rasa beatll" (11111 -ill 1ec' <br />l, ardb9 systems) <br />20 <br />1 <br />Deslynated Facility Omer w Operator: Cerdha8m of recdpf of hazadoa m t mate cuvvae by lb ma dPat acepl a nobd m Nam 18a <br />R teNTyped Name Signaare <br />Month Day Veer <br />I I I <br />_PA Fon- 8700-22 (Re,. <br />are obsolete. <br />