Laserfiche WebLink
Pie aseprint or type. E R J Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1r Generator Number T-F-91777 3.Emergency Response Phone 14.Manifest Tracking Number <br /> W S: �7, <br /> T MANIFEST <br /> L ii <br /> rE MANIF ES 1' L_ _ 335 <br /> 5 5 <br /> WAS E MANIFEST CAL0003933635 1 5 '21669 014027527 FLE <br /> 5,Generator's Name and Mailing Address Generator's Site—Address(if different than mailing address) <br /> O' Reilly Auto Parts#3810 <br /> 4178747257 1551 WEST MAIN STREET 1551 WEST MAIN STREET <br /> Generator's Phone: RIPON, CA 95366-3012 RIPON, CA 95366-3012 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNSOOOII0924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Name and Site 5 <br /> D C, <br /> 8.Designated aFe; si rmr—y—m, T U.S.EPA ID Number <br /> 2-095 Newlands Dr. East <br /> Fernley, NV 89408 <br /> Facility's hone., <br /> 1 5338 <br /> 9a. 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)) E— Wt/V 13.Waste Codes <br /> EN o. Type Quantity Wt./Vol. <br /> w X UN1993, Waste Flammable liquids, n. o. s. I D 4MO 0 0 7 V071 P 21 DO O I <br /> 0 <br /> (Acetone, Methanol), 3, PG II, ERG#128 <br /> Z 2. <br /> LU <br /> 3. <br /> 4. <br /> 14.Special—Handling Instructions and Additional Information 1. 100670(Flammable Liquids) <br /> 15. GENERATOR'S/OFFEROR'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(t)(if I a a small cl tity gen III/—true/ <br /> Generator's/Offeror's Printed/lyiclNanne Signature % Month Day Year <br /> r <br /> + 1 101 L2E-0 <br /> L <br /> _j 16.Interna lW—al—Ship Ments <br /> Import to U.S. C- Export from U.S, Port of entry/exit: <br /> JU.S-:Transporter signature(for exports only): Date leaving US <br /> 0: 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> 0 <br /> Z Transporter 2 PrintedFFYC:�N�- Signature Month Day Y <br /> < rl`,� L,�— f-—, 11� <br /> i I n- (10 /02 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space 0 ❑Quantity El Type El Residue El Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> '18b.Alternate-fa�''Ft�(or-Gener-a r) <br /> chern ProCe-65inc, P C-7pot" of KC)rtrLZrIlLAIumber <br /> 31--?-g2j-f 758-qt) -12-1 <br /> Facility's Phone: S<2-)4 M ID q 2/2 6 1-52 Ct <br /> LO 18c.Si of Alternate Facility(or General Day Y <br /> U <br /> Generator <br /> Z <br /> a t M, <br /> L1 Hazardous Repo Method�G. c,(i.e.,co� <br /> 1 rd ",W'to . M <br /> 0 � K, R port Management Method Cc es codes for hazardous waste treatment,disposal.and recycling systems) <br /> LU 1 i2. 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 /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DE, GNAI'ED',1",AXU-1TY 1'0 EPA's <br />