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I I II llllllillllll Illillllllllllllllllllllllllllllllll .IIIN u:f� � ! � Form Approved.OMB No.2050-0039 N� Fo pp ERI, �,� _.�,�, Please print or type. 4.Manifest Trackin Number =ARDOUS .Generator ID Number 2.Page 1 of 3.Emergency Response Phone 015�2 6464 FLE UNIF1 (877) 577-2669WACAL000394668 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) O' Reilly Auto Parts O' Reilly Auto a Part--#4719 (417) 874-7257 15079 S HARLAN RD 15071 5 HARLAN RD LATHROP, CA 953-0 LATHROP, CA 95330 Generator's Phone: U.S.EPA ID Number 6.Transporter 1 Company Name Clean Earth Specialty Waste Solutions �lil��u�j�11'�� c U.S.EPA ID Number 7.Transporter 2 Company Name B.Designated Facility Name and Site Address` sCentury E N, LLC U.S.EPA ID Number x:'095 Nevilands Dr, East Fernley, NV 89408 ' X575 NVD981895338 Facility's Phone:77`r'-r`.3760 ' 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes and Packing Group(if any)) No. Type Quantity Wt.N01. HM D001 76, Waste amma a igui s, n. o. s. 00000 ' X14 ea 3, PG II, ERG#12$ o (Acetone, Methanol), -.-� r on- agar ous, ort- egu a e o i s t o a r4sh, F 0 002 ' i81I 0 Sulfuric Acid), 3. } + 6 14.Special Handling Instructions and Additional Information am m a e +: v `�+ 0 d 1 a eY'V Acid) 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, 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 EPAAcknowledgment of Consgo. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if 4fi a small antity ne or)is e. Month Day Year ;nator's/Offeror's PrintedlTyped Name Si na e04 4 '021ional Shipments Import to U.S. Export fro U. ort f entry/exit: Dat leaving .S.: r signature(for exports only): 17.Transporter Acknowledgment of Receipt of Materials Month Day Year LU Transporter 1 Printed/Typed Name ignatu e 04 27 '02.1 a Anthony Mack Month Day Year Z Transporter 2 PrintedlTyped Name Signature 18.Discrepancy ❑18a.Discrepancy Indication Space Quantity El Type ❑Residue ❑Partial Rejection Full Rejection Manifest Reference Number: U.S.EPA ID Number 18b.Alternate Facility(or Generator) J_ V LL Facility's Phone: Month Day Year LO 18c.Signature of Alternate Faciiity(or Generator) Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 3. Y4.0 1!, I U)0 1 D LAN-- 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest ex in Item 18Month Day YearPrintedlTyped Name rEPA Form 8700-22 Rev.12-17) Previous editions are o solete. DEN EPA's e-MANIFEST SYSTEM 8700-22 1003 CA!40000003 S410977�-'9 - 0142059751 M PD04f 7?+. r-aT)042721