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0 <br />Please pant or . (Form designed for use on elite (72 -Pitch) typewriter.) <br />0 <br />Form Appoved OMBN <br />:PA Form B7D0-22 (Rev. 3-05) Previow editions are obsolete. <br />UNIFORM HAZARDOUS i' Gererzu ID Number2. <br />Page i of <br />3 Emergency Reapalse Phone <br />4T o. 2050 uud9 <br />""0"� ° 11 "3 <br />WASTE MANIFEST CA0981675093 <br />1 <br />209-946-55M <br />01 G B F <br />5.Oarerabls Name and Mating ACdreu Generab/a Site Address Id dmerent than ma <br />SAN JOQAUIN REGIONAL TRANSIT � �cress) <br />P.O BOX 201010 <br />1533 LINDSAY <br />STOCKTON, CA 95201 <br />x_208-84&5566 STOCKTON, CA 95202 <br />8. TmnWorw 1 Ca parry Name U.S. FPA ID Number <br />AMERICAN VALLEY WASTE OIL, INC. CAL000827878 <br />7. Trermpone 2 Canperry Nemo U.S. EPA ID Number <br />bf ,t O <br />8. Designated Feebly Nero Address U.S. EPA ID Mmber <br />21ST CENTURY ENVIRONMENTAL MGMT OF NEVADA <br />,LLC <br />2085 NEWLANDS DR. EAST NA7D980885338 <br />FERNLEY, NV 89400 <br />F a Ptwns: 775-575-2760 <br />9, <br />9b. U.S*bd <br />DOT Deaaon (kduckV PrOW Sh4WV Name, Harard Cay, ID Number, <br />10. Canfaben <br />11. Total <br />12. Unit <br />HM <br />and Paddq Group (0 ay)) <br />Oue sly, <br />WUVd. <br />13. Wale Codes <br />W. <br />Type <br />1' NON-RCRA HAZARDOUS WASTE LIQUID <br />G <br />W <br />(BRINE ANTIFREEZE SOLUTION) <br />.D� <br />p <br />1 <br />i <br />2 <br />2 <br />� <br />1 <br />3. <br />i <br />r <br />4. <br />f <br />14. SPeclal HaMlrg autrurdm. aro Addborw INansbon <br />PROFILE M 40484-00 <br />15. GEIS ATORSIOFFEROR'S CERTIFICATION: I hereby declare that t s cPnwds of on az Urm t are hely and aweabty desaBed shorn by the proper sNppg name, and n yyadYd, padagad, <br />marked and "d9#1a®ded, and are b y teepee, b prober cawom fer transport wwroev b ePPbcabte tdana8aial and naEaid a8oina aepaM1 eA®nrMand l am the FrM1rury <br />Exporter. I c * that the contents d thismregmsnt conform to the tams of the attached FPA Adcr ,f consentgOVBf"'"°"w <br />I stay amt err waste mkwnm3am statement idended b 40 CFR 28227(a) (a I am a large gyntky pwakn) or (b) (dl am a surae quanaty W wm,) 4 true. <br />Monro3 q las W ea <br />Al R7y' �ik/C- s -� <br />—e <br />Ia. Inwnatlorsl SNprneaa <br />U.S. ❑F�pon hen U.S. Part of entry/art <br />Treaspatar slpubee(far exports oryy❑Impatb <br />Dab bevtng U.S.: <br />W <br />17. TrssporWASPloabdg wt of Recess of Mawtab <br />Transporter 1 7WdITyped NaM Sgrskn Murat Year <br />n <br />< <br />Tm .2 Yt>ed S D <br />Well sY <br />I q <br />t18. <br />Discrepancy <br />18e. Dlscrepaay IMkaBon Speoe ❑ Amy ❑ Type ❑ R.A. ❑ Partial Rgsdbn ❑ FW R*W, <br />ti <br />Manfat Rehnenm Number: <br />18b. Alternate Faddy (or Generator) U.S. EPA ID Number <br />7 <br />J <br />i <br />FwfVs Plein: <br />y <br />18c.S91"mrs ofAltainale Faciky (a Gereremr) <br />Meeh Day Yea <br />LD :1:9:Hmadoue <br />6Vata Report Mmvgertsm Meaxad Cody (.e., codes far hazardous waste hwebnet, disposal, and rnzydkg syslens) <br />L <br />1. 2. <br />m Designated Facilhy Owner or Operation CeNAwtlon of receipt of hazardous matelots covered by the nwJfyt e as Med'n ftem 18a <br />1 <br />P YPW NameRept <br />SyluMre Month DaY rear <br />:PA Form B7D0-22 (Rev. 3-05) Previow editions are obsolete. <br />