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089 <br /> PleaseERI Provi <br /> 'print or type. 200108905 E 42324462 <br /> der: Cleann Earth form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000393335 1 (877)577.2669 200108905CLE <br /> 5.'Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> O'Reilly Auto Parts O'Reilly Auto Partsill <br /> 1551 WEST MAIN STREET 1551 WEST MAIN STREET <br /> RIPON,CA 95366 Ph:4178747257 RIPON,CA 95366 Ph:4178747257 <br /> Generators Phone: <br /> 5.Transporter 1 Company Name U.S.EPA ID Number <br /> Clean Earth Specialty Waste Solutions MNS000110924 <br /> T i-ransporter 2 Company Name U.S.EPA ID Number <br /> 8.P esignated Facility Name and Site Address U.S.EPA ID Number <br /> 21st Century EMN,LLC NVD980895338 <br /> 2695 Newlands Dr.East <br /> Flrnley,NV 89408 <br /> I'Lilitys Phone: 7755752760 <br /> I ga, 9b.U.S.DOT Descriptm(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> ny)) <br /> HM and Packing Group(if a 13.Waste Codes <br /> No. Type Quantity Wt.Nol. , <br /> K 1.UN1993,Waste Flammable liquids,n.o.s.(Acetone,Metharl 3,PG ll,ERG#128 214 D001 <br /> X 1 CF 08816 Is + <br /> z 2. <br /> I <br /> r <br /> 3. <br /> 4 <br /> + i <br /> 14.Special Handling Instructions and Additional Information <br /> 1&00670gnammable Liquids) <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 labeledlplacarded,and are in all respects in proper condition for"report according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cargy that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I pertly that the waste minimization statement idenfified in 40 CFR 262.27(a)(RI am a large quandly generator)or(b)(ifI am a small quantity generator)is we. <br /> G,.. t tslORerofs PnnledlT etl Nam Sig lure Month Day year ; <br /> t 031 22 120221 <br /> 1 linternaltorral Shipments <br /> z ❑Import LLS ❑Export fro -Port of en exit <br /> Transporter signature(for exports only} Date Tear U. <br /> W 17:Transporter Acknowledgment of Receipt of Materials. <br /> K Transporter l Printed/Typed Name i <br /> Sign Month Day Year <br /> a Anthony Mack03 22 2022 <br /> z Trnsporter2 PrintedRyped Name Signature Month Day Year <br /> } 18.Discrepancy <br /> 18p.Discrepancy indication Space ❑ Quantity ❑Type ❑R ❑ <br /> esidue Parfial Rejection ❑Full Rejection , <br /> I <br /> 186.Ntemate Fadlity(or Generator) Manliest Reference Number: <br /> U.S.EPA ID Number <br /> J I <br /> U <br /> LL FaNiVs Phone: <br /> Lu 18c.SignatumofNlemare mobility(or Generator) Month Day Year <br /> a ' <br /> z <br /> y <br /> IS? <br /> }tH,abbardous sWWaste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 7 7 f 1 2 <br /> 3. 4 <br /> 20:Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manliest except as noted in Item 18a <br /> PnoledQyped Name S1 nature <br /> 1 1 y� C(114Month Day Year <br /> EPA Form 8700-22.(Rev.121-17) Previous editions are DbsoTete. <br /> DESIGNATED FACILITY TO EPA's 6-MANIFEST SYSTEM f' <br />