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Please print or type. 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 CAL000429472 1 877-577-2669 014904074FLE <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> O'REILLY AUTO PARTS 3811 1950 MCHENRY AVE <br /> 233 S PATTERSON AVE ESCALON CA,95320 <br /> SPRINGFIELD MO,65802 <br /> Generator's Phone: 417-520-4589 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS000110924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS000110924 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 21st Century Environmental Management of Nevada,LLC NVD980895338 <br /> 2095 Newlands Drive East <br /> Fernley NV,89408 <br /> Facility's Phone: 775-575-2760 <br /> 98 91a.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.N01. <br /> 1.UN1950,Waste Aerosols,Flammable 2.1,ERG#126 D001 <br /> 0 X 1 CF 6 P <br /> /� 214 <br /> Z 2. <br /> LU <br /> C9 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 1)100663(Aerosols,Flammable);Line 1: <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(b)(if I am a small quantity generator)is true. <br /> Generator's/Offeror's Printed/Typed Name Signature Month Day Year <br /> Daniel Vargas Daniel Vargas 05 04 1 2020 <br /> -J 16.International Shipments <br /> Import to U.S ❑Export from U.S. Port of entry/exit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> W17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter Printed/Typed Name Signature Month Day Year <br /> 0 Jared Marciel Jared Marciel <br /> a I I 05 I 04 12020 <br /> N <br /> QTransporter 2 Printed/Typed Name Signature Month Day Year <br /> NA NA 05 04 2020 <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL <br /> Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU G 1. 2. 3. 4. <br /> H141 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedlTyped Name Signature Month Day Year <br /> Alma Luoto Alma Luoto 05 13 2020 <br /> EPA Form 8700-22(Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />