COMPLIANCE INFO_2022 - Laserfiche WebLink

Home Browse Search

Please print or type. -' E R . Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST GAL000394668 1 (877) 577-2669 012496242 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) O' Reilly Auto Parts O' Reilly Auto Parts#4719 (417) 874-7257 15079 S HARLAN RD 15079 S HARLAN RD Generator's Phone: LATHROP, CA 95330 LATHROP, CA 95330 6.Transporter 1 Company Name U.S.EPA ID Number Stericycle Specialty Waste Solutions inc MNS000110924 7.Transpodft2 Cop y Name U.S.EPA ID Number 8.Designated Facility Name and Site Address 21st Century EMN, LLC U.S.EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 NVD9 895338 Facility's Phone: 9a, 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. ® X 1. LIN1950, Waste Aerosols, Flammable 2. 1, ERG#12E 1 CF 00024 P 214 D00t W I LU 2. 4 3. 4. I I 14.Special Handling Instructions and Additional Information 1. 100663(Aer O s o l s, Flammable) 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, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of 9ensent, I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or I am a small quantity generator)is true. G ner s/Off edlTyped N Signature Month Day Year 1 0 20 0 J 1 \1 \T)"- 5 . I � 6.International Shipments Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year a Kristo her Almanza It 04 20 0 Transporter 2 PrintedlTy�'d�Name Signature /) Month Day Year w f 18.Discrepancy 18a.Discrepancy Indication Space El Quantity El Type esidue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: F 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone. w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. j4l y'l n ated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a ed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM