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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL00031LIW 1 2023-334-.3'586 I ? tr� "�� <br /> �, B <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> ACME SAW&SUPPLY-LOCI <br /> 214 N.SACRAMENTO ST <br /> LODI,CA 95240 '7 C <br /> boy-334-3396 <br /> Generator's Phon . <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> KAFRICAN VALLEY wmm OIL, INC, CAROU02723W <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> STERICYCLE SPECIALTY WASTE SOLUNONS, INC MNSOM11M4 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> GEIus RMCHO COY DOVA, LLC. CADS80884183 <br /> 118525 WH'TE ROCK RD. <br /> RANCHO C ORDOVA, CA 95742 <br /> Facility's PhoneP16-351-0W) <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13,Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt./Vol. <br /> X 1. RQ,UN1268,1/I/A,TE FLAMMABLE LIQUIDS,N.O.S.,3,Pr;11, 1 17M 55 G D001 U018 3' <br /> GASOLINE,q1L <br /> LU 2. <br /> LU <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information <br /> PRC)FILE# 9153W01 GAS,OIL ERG#128 <br /> EMERGENCY CONTAC;'T:MONICA <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: 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 /> marked and labeled/placarded,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 /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generator's/Off ror's Pr' tediTTypttuuTE <br /> ped ame Sign l ��j Month Day ., Year <br /> lo <br /> x V I .raw <br /> 16.International Shipments W <br /> F 11Importto U.S. Export from U.S. Port of entry/exit: <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> W 17,Transporter Acknowledgment of Receipt of Materials <br /> Transr rin ed/Typ d Name Signatur .•—^" """ Month Day Year <br /> z Trd sport yped NaMe ✓Signa re -� Month Day Y r <br /> - 2 t <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> Facility's Phone: <br /> LU 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> h� 1, t 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrinledlTyped Name ' i Signature j' Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. �,!" DESIG A rACII ITYTO GENERATOR <br />