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Please pTtnt or type. f Form Approved OMB No.205'--003 9 <br /> UNIFORM HAZARDOUS 1 Generator ID Numt of Z.Page 1 of 3 Emergency Response P7one 4.ManifestTraeking Number <br /> WASTE MANIFEST J J K <br /> CALOODOUZ75A219-334-IjOIDITI -0235"83216 I <br /> 5 Genefatars Name and 6AokV Address Generators Site Add rass of different than mailing addressl <br /> PAUL VAI TRUCKING INC <br /> 4740 E PELTIER <br /> ACAMPO,CA 85220 <br /> Generator's Ahon <br /> 6.Transporter t Comparry Name U.S EPA ID Number <br /> AW&RCM%IkLLEY Rill OIL,WG. CARC0027' <br /> 7 Transporter 2 Company Name _ LIS CPA ID Number <br /> CLEAN EARTH MN:irJQUI IOW4 <br /> x.Desgrrated Fapity Name altd Sita Address. if S.EPA ID Number <br /> 21st CEK"'y WAROMEN1AL WGUI OF NEVAQk LLL FVD080896336 <br /> 2M NEWLAt"DR.EAS <br /> FERNLEY NV 110406 <br /> Facrlitv's F'hpre.l?'y'�jam' ] <br /> ga 9b.LI.S.DOT Desor ptron;mrluung Proper Shipping Name.-iazaM Glass.ID Number, ?0-Containers 11 Total 12 Und <br /> G <br /> ng roup of anyyi 1.3.YVea€e <br /> HM and PackiCodes. <br /> No. Type Quantify wt riot. <br /> 1 <br /> cc �' I-f�2$7 JVX5 i F F'04;?R414WF LKXAD.a*W.(A4AW.N 0$-. 1 [7Fu1 7� �1 <br /> "RC)XIEW <br /> L hK*0kCFU eW-MUCX15 WAS1 E LIQUID,XSMi&T EY AMON 0111A <br /> 3 <br /> n <br /> = Speual-Ia:dl.ny Instrucbori�,,and Additional Indormatior <br /> PROF ILEO 17 1896&4)U ZEP COWRVb CLEANER EHi.4 153 2.PROFILE/ 17YWJ53-00 AtiPI^Y1ll1,T ENKII-540N ERG&171 <br /> EWR cc"rAcr vicToFt A <br /> 1 <br /> G E NERATOR'SWFEROWS.CERTIFICATION: f trereby decare That the contents of thF9 consrynment are fully and accurately described dove by the proper shipping name,and are dassified,oacicagsd, <br /> -narked and labeladrplecarded.and are mn Wl respects Ir,proper cQRditi m for transport acceding to apphcaNe inlammonal and nabonai govemmental regulations.If export shipment and I am the P,�mary <br /> Exporter.I oer*that lie eantents of the consVnment wnform to the terms of the attache-d EPAAckwWedgrrrnt of Conssanr <br /> I certify RIM"was"rSmin m�tsliarr staternem identified in 40 CFR 262 27[a)14 t am a tame quantfty generator)ar r. al gernrator)is titre <br /> Generator'slOff ;or`s Prm agqd N . Signature f -�'I Mg�h � Year <br /> �� � i •hili,! i� / <br /> FiS.irtemadonal Shipments ❑Import ro U.S ❑Export from U.S: %rt ofen ;exit <br /> ? Transporter signature(for exports only): Date lenw U.S. <br /> I= 17 TronVorV AckmMedgrnent of Receipt of Materials <br /> W ad T <br /> Tra 1 Pnntyped Name Sig Mon gay <br /> ov. <br /> CL Z� za=z <br /> Trans -ter 2 Pnntedfi ame fWature IkgTth f_j <br /> F- �J <br /> F- <br /> 18.Discrepancy <br /> 1&.Dscrepancv Indication Space ❑ Ouanhty LJ 7 ❑Residue ❑Partial Re cz <br /> Type fec° ❑Full Rejection <br /> N'rnifest Reference Number <br /> AEtemale Facility(or Gener%arj5.EPA ID Number <br /> 13t CLIVI of A° <br /> has the Onpr r,a.e <br /> LL Facdifys Phone: FOr <br /> W 9 8e S gnature of Alta mate Far airy{or Generator) th+S ( •• hAond: Cay Year <br /> a 9er+ef at <br /> z <br /> L►3 <br /> 19 Hazardous Waste Report Managemenl Method Codes{I e.,oAes for hazardous waste treatment,disposal,and regd rig systems) <br /> IJJr 2. 3. 4 <br /> 29 Designated Facility Owner or Operator:Cerryecation of receipt of hazardous materials cavered by the manilesi.except nrted in Item 18a <br /> Pdrted';yped Name *nature Month Day Y: r <br /> EPA Form 8700.22(Rev.12-17) Previotfs editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />