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06 / 11 / 2021 1 : 51 PM FAX 2099488625 AMCE SAW 0001 / 0003
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<br /> �Pleasa'pnir# or typB:, ral Form Approved, OMB No. 2050.0039
<br /> UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3. Einargeney Response Phone 4, Manifest hacking Humber
<br /> WASTE MANIFEST CAL000178438 $t74 T46 7148 ?rtLot',to 1 G B
<br /> ;. Generator's Name and Malting Address OF
<br /> Generator s Situ Addroee ('d different gran mbiing address)
<br /> ACME SAW
<br /> 1204 E MAIN ST
<br /> S'TOCKTON , CA 95205
<br /> GonarMor's Phor3OD3'94"735-105
<br /> 6, Tronoporter 1 Company Name U.S, EPA ID Number Sol
<br /> AMERICAN VALLEY WASTE OIL , INC. CAR011=72
<br /> 7, Trour portor 2 Company Nama US% EPA ID Number
<br /> SFMRICYQL.E SPECIALTY WASTE SOLUTIONS , INC MNS000110924 �-
<br /> ff. Designated Facility Nome and Site 'AddtessG M- IiANGhG i :ORD4VA, LIC U,$, EPA ID Number ,. r ,
<br /> '11855 WHITE ROCK RD. C'AD980884183
<br /> RANCHO CORDOVA, CA 95742
<br /> Fod6ty's Phonp13y351-t�3f30
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<br /> Ab, U,S, DOT Description Qnclud'mg Fropsr Shipping,Name; Hazard Class, ID Number, 10, Containers 11 . TateI 72. Unit 13, waste Codes
<br /> HM and Packing Group (it any)) N0, Type Ckrantity wtJVoi,
<br /> K 1. RQ UM1093, WASTE FLAMMABLE LIQUIDS, M.b .S. , 3 , PGII , 1 DM 55 G D001 D018 331
<br /> EQ- GASOLINE, OIL
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<br /> 14. Special Handling instructions and Additional Information
<br /> PROFILE # 40857-Q4 GAS & OIL ERG^# 128
<br /> EMERGENCY COWACT: MARY '
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<br /> "• 18: 'GENERATOR'SIOFFEROR'S`CERTIFICATI©N: ' I1rCroby'tlotlfroihatihecoMent"I'thisconslgnmentoatefuliYand accuratelydesortedabove•bythe proper, shipping name;andare classfied; packaged,••• ._ _
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<br /> Marked and labeled/placarded, and are In all respects in proper condition for trensport according to applicable intamationbiand national governmental regulations. If export shipment and I arn,the Prlmory
<br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgm Consent.
<br /> 11 I cattily gist the waste mkllndZaUon statement identified in 40 CFR 262.27(x) (if t am a large quantity genera or (bj (ifl am a II q bng snarblor i
<br /> Oe Offerofs Prince ; pa Signet a Month Day, Year
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<br /> J 16. International Shipments
<br /> F,,. ❑ Import to U.S. ❑ EcportfromI18, Portofentry/exit:
<br /> Transporter signature (for exports only): Date leaving U.S.:
<br /> C 17. TransporterAcknowledgmentofReceipt ofMaterials
<br /> F . ' Tre)iaB4tterl? Pdn ;me • " '.. " '' Sat I ,rgne Day
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<br /> 1' ' Trane otter ri ed a ' ' pop . Sign re + fd :. Day; .
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<br /> 18a. Discrepancy Indication Spacep an El
<br /> Qdantity Type • Reauius ❑ Parts[ Rejection 'Full Rejection "
<br /> Manifest Reference Number. `: '
<br /> i8b. AlternateFed ityoregbrar 'r nV� j. j111104111 U.S EPAID,N pati
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<br /> LE FaCality�s Phone; - :, !vPP c U
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<br /> LLI18c. SignatureofAitemateFecOity (orGena or this $$� �#C�5 shipp�n�Ee Month Day Year
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<br /> Op 1g. Hazardous waste Report Management Meth odes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) , ,
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<br /> 20. Designated Fack Owner or Operator: cadifrcatlon of receipt of hazardous materials covered by the manifeat•except as ndad in Itom 18a '111111 r �
<br /> pflntedliy led Name. Signature Month nay Year
<br /> EPA Form 13700-22 (Rev. 12ol Previous edlttons are obsoleth. 1 p L DESIGNATED FACILITY•TO GENERATOR
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