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Please print or type,(Form des�lnad for use on elite(12-pitch)typewfilerl Form Approved,OMB No.2050-0039 <br /> UNIFORM I HAZARDOUS 1 1.Gelle",to(ID Numbor 2.Page I of 13.Emergency Resprisie Phr" -4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000381216 p,0_3 aa47_5_ G B F <br /> 5,Gelicralor`5 Name and Mailing Address Geneliator's Site Address 0 diff0fil"t than maIM9 address) <br /> BILL'S MOWER AND SAW <br /> 852 N.MAIN ST <br /> MANTECA,AE 95336 <br /> G Transporter I Company Name U.S.EPA st1 Niamt?et <br /> AMERICAN VALLEY WASTE OIL, INC. CAR0011272302 <br /> 7 Transporter 2 Cornpany Name U.S EPA ID'Number <br /> STERICYC LE SPECIALTY WASTE SOLUTIONS, INC MNS0001 10924 <br /> 8.Designated Facility Name and Site Address CHEMICAL RECLAMA'FION SVCS U.S.EPA lD Number TX0046844700 <br /> 405 POWELL STREET <br /> AVALON,TX 76823 <br /> Facility's Phone972-627-3224 <br /> 9& 9b.U.S.DOT Description(including Proper Shipping Varve,Hazard Cass,10 Number, 10.Containers 11.Total 12.Unit lVNasle Codes <br /> HM and Packing Group(ifany)) No. Type Quantity WI.Nol <br /> X- 1, RQ,UN1993 WASTE FLAMMABLE LIQUIDS,N.O.S.,3, PC711, I DM 55 G D001 D018 331 <br /> 0 GASOLINE, OIL OUTS 2111{ <br /> Z Z <br /> 0 <br /> 4 <br /> 14.Special Handling Instructions and Additional Information <br /> PROFILE#868367-00 AGED GAS&OIL ERG#128 <br /> EMERGENCY CONTACT:CRAIG <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and&,.,urarteiy described above by the proper shipping name,and are classified:packaged, <br /> marked and labelediplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations If ex ipment and I arn.the Primary <br /> Consent.Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknuNladgmenl 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 arrnta s-n uainlity <br /> GenerwesliOlfferor's P nt yped Name Signature -"r)nIh Day Year <br /> 3tt, <br /> ElImport to U.S. EJ Export from U,S. try"exit: ..._.....w.................. ................. <br /> Transporter signature ifolt exports only}: I!leaving U.S.: <br /> 17,Trampwter Acknowledgment of Receipt of Matels <br /> Transl P ted Name Month D <br /> V <br /> 0 <br /> --ironth Day Year <br /> :Z P481) flat FrflDVfry*Nrin signature <br /> < <br /> M 18.Disc*paincy <br /> P.di I Rejection <br /> 18a.Discrepancy Indication Spare Q.anfity Type L-J Residue F la Full:Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S,EPA ID Number <br /> LL. Facifilys Phone: J <br /> 11=11 onth Day Year 18c.Signature of Alternate Facility(or Gonaralor) <br /> 19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLJ <br /> 1 12 3. 4 <br /> 20,Designated Facility Owneror Operator.Certification of receipt#hazardous materials covered by the mar#g i-+t as noted in Item I Ba <br /> Printedat 0 <br /> I 'Ju <br /> L!j�UZ, D, -2 !K <br /> EPA Form 8700-22(Rev.3.05) PreviouTeditions are obsolete. <br /> DESIGD FACIL ITY TO DIFSTINATION'$1 AT <br /> E ff REQUiRED" <br />