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TT �1 Y <br /> Please pant or'dype:(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 „ <br /> UNIFORM,HAZARDOUS 1.Generator ID Number 2.Page 1 ofr3Emergericy Response Phone 4.Manifest Tracking NumberWASTE MANIFEST CAL000381218 a7- .8 G B F <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing dress) <br /> BILL'S MOWER AND SAW <br /> 852 N.MAIN ST <br /> MANTECA,AE 85336 <br /> Generator's PhorROD. a <br /> 6.Transporter 1 Company Name / U.S.EPA ID Number 1 <br /> AMERICAN VALLEY WASTE OIL„INC. CAR0002723W <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> 1 STERICYCLE SPECIALTY WASTE SOLATIONS,INC. MNS000110924 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CHEMICAL RECLAMATION SVCS TXD046844700 <br /> 405 POWELL STREET <br /> AVALON,TX 76A23 <br /> Facility's Phone972-827-32211 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> X 1.RQ,UN1893 WASTE FLAMMABLE LIQUIDS,N.G.S.,3,PG11, 1 DM 55 G D001 D018 331 <br /> o GASOLINE,OIL OUTS 211H <br /> Z 2.LU <br /> ;(i <br /> r 3. <br /> 4 <br /> i 14.Special Handling Instructions and Additional Information <br /> PROFILE#868367-OCI AGED GAS 8r OIL ERGIIIll t <br /> EMERGENCY CONTACT:CRAIG <br /> x <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 regulatio�expoipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenl 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 l am a s antity generator)is t <br /> Generator'sl0fferor's Printe ypedName Signature Month Day Year <br /> -1 16.In ahonal ipme 's <br /> ❑Import to U.S. ❑Export from U.S- rt of entrylexit: <br /> Transporter signature(for exports only): ate leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transp a tedff p Name idrC"" Month Da Ye r <br /> O / <br /> a <br /> Z T pode yped Na �` ignature nth ay Y r <br /> I-- IP A T <br /> IF <br /> 18.Disc p cy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residuej j <br /> ❑Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> _J <br /> V <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> • Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> v C 1. 77-- <br /> 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manyest jxt as noted in Item 18a <br /> Tn t dI yP)I d N m ,w <br /> S nat"e I M th ay r• <br /> /J <br /> EPA Form 8700'12-(Rev.3-0 Previou edi Ions are obsolete. f <br /> 13023.0NONATED FACILITY TO GENERATOR STATE(IF REQUIRED) <br />