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Please print or type. E R I Form Approved.OMB No.2050-0039 <br /> F 1 G;Z;t- D6N;b1'r— <br /> UNIFORM HAZAR�DOUIS 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE <br /> MANIFEST <br /> C <br /> L <br /> 43 <br /> C�� 78 <br /> 3 :""+78 <br /> _L L <br /> WASTE MANIFEST CAL000392478 1 (877) 577-2669 <br /> LWA027521 FLE <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> O' Reilly Auto Parts#2567 <br /> 4178747257 1440 EAST HARDING WAY 1440 EAST HARNG WAY <br /> Generator's Phone: STOCKTON, CA 95205-3104 TOC Els CA 95205-3104 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number — <br /> St MNS0001IL4924 <br /> 7.Transporter 2 Go U.S.EPA ID Number <br /> S, to so )3"5: <br /> "Ify <br /> 8.Designated salty U.S.EPA ID Number <br /> 21095 Newlands Dr. East <br /> Fernley, NV 89408 <br /> Facility's Phone: 7755752760 NVD980895338 <br /> 9a, 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total <br /> Q; 12.Unit <br /> HM and Packing Group(if any)) Wt N)l 13.Waste Codes <br /> No. Type Quantity Wt./Vol. <br /> L <br /> Zc <br /> FUN1950, Waste Aerosols, Flammable 2. 1, E�-G#126 I 5F— OOL-422 2145 DOII� <br /> 0 <br /> ------------ <br /> Z 2. <br /> ca <br /> LU <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information 1. 100663(Aerosols, FlaMmable) <br /> 15. GEN ERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,at 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/Offeroc inted/Typed Name Signature Month Day Year <br /> YA iv L49 <br /> 16—international Shipments <br /> El Import U.S. L Export from U.S, Part of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> LLJ — <br /> Transporter 1 PrintedrTyped Name Signature Month Day Year <br /> R Jared Marciel1 091 301202(t <br /> Z Silo, Month Day Year <br /> - <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity Type ❑Residue ❑Partial Rejection 1:1 Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator)pe em Procescsing or-mipof-NorbuU.1 ERA plumber <br /> c-4- <br /> 5,319-924-53"1 / <br /> Facility's Phone: .42,1 L.,11-3C-OStF, �A I h 6 0^�j <br /> LU 18c.Signature of Alternate Facility(or Generator) 0 Dam at <br /> � M77t <br /> Z <br /> (D - ---------- <br /> V) 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJ <br /> 1. 12, 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 /> 5—rintedilTyped Name Signature Month Day Year <br /> EPA <br /> earEPA Form 8700-22(Rev.12-17) Previous editions are obsolete. D[',,.dGNA'TED FACU1.111TY`0 EPA",s,&,,N4b,`\j,,,`�C TEM <br />