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� III IIIIII I VIII II II II IIIIII <br /> 20025189GCLE 42460862 <br /> Please print or type. ERI Provider: Clean Earth Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS t.Generator 10 Number 2.Page 1 of 3.Emergency Response Phone d.Manifest Tracking Number <br /> WASTE MANIFEST CAL000394668 1 (877)577-2669 200251880CLE ` <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> O'Reilly Auto Parts O'Reilly Auto Parts#4719 <br /> 15079 S HARLAN RD 15079 S HARLAN RD o <br /> LATHROP,CA 95330 Ph:(417)874-7257 LATHROP,CA 95330 Ph:(417)874-7257 <br /> Generators Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Clean Earth Specialty Waste Solutions MNS000110924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA IO Number <br /> 21st Century EMN,LLC NVD980895338 <br /> 2095 Newlands Dr.East <br /> Fernley,NV 89408 <br /> Facilit)<s Phone: 7755752760 <br /> 9a 96.U.S.DOT Description jinauding 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/Vol. <br /> 1UN1950,Waste Aerosols,Flammable 2.1,ERG0126 214 I D001 <br /> 0 X 1 CF 00002 P -a......�__.... , <br /> Z 2. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 1.100663(Aerosots,Flammable) <br /> 15. GENERATOR`SIOFFEROWS 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 Iabelediplacarded,and are in all reenacts in proper condition for transport according to applicable international and natio al governmental regulations.g export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment canfonn to the terms of the allacned EPA Acknowledgment of Consent. <br /> I candy that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)fif I am a all quantity gayrat_0 is We, <br /> e aloes(Ogerors PnnledTyped Name Signature Month Day Year <br /> 09 1 14 12022 <br /> 16.International Shipments <br /> 1— ❑Impar to US. ❑Export tram U.S. Po ryiexit: _- -- <br /> M Transporter signature(for exports only): Date leaving U.S.: <br /> C 17.TransporterAckrwwwedgment of Receipt of Materials <br /> Transporter 1 Prinled/ryped Name Signature Month Day Year <br /> a Brian Ringler <br /> 09 14 2022 <br /> Qi Transporter 2PnntedfTyped Name Signature Month Day Year <br /> C <br /> r <br /> j18.Discrepancy <br /> 18a.Discrepancy Indicatbn Space ❑ Quantity ElType L1Residue ❑Partial Rejection ❑Full Rejemon <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> W Faality's Phone'. Y <br /> W 18c.Signature ofNtemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. x <br /> 1 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as naed in Item 18a <br /> PnmedTyped j.me Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />