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Form Approved.OM13No
<br /> onse Phone 4.Manlfe rA 8 7 2r9 2 8 J J K
<br /> Emergency Resp 8 7 Z
<br /> 2.Page 1 of 3• -�
<br /> Please print or type. 1.Generator ID Number
<br /> UNIFORM HAZARDOUS t;AL000'182804 Generator's Site Address(if different than mailing address
<br /> ATE MANIFEST
<br /> 5.Generator's ame and Mailing AddressPREMIER FINISHING
<br /> 7910 S LONGE A S y5206
<br /> STOCKTON, U.S.EPA ID Number CAR000272302
<br /> 209-982-5W
<br /> Generator's Phone'.
<br /> U.S.EPA ID Number Wg000110924
<br /> 6.Transporter l CompanyName AMERICAN VALLEY WASTE OIL.INC
<br /> U.S.EPA ID Number
<br /> 7,Transporter 2 Company Name CLEAN EARTH NVD980895338
<br /> B.Designated Facility Name and Site Address 21S1 CENTURY ENVIRONMENTAL MGIAT OF NEVADA,LLC
<br /> 2095 NEW LANL'S DR.EAST
<br /> FERNLEY,M( 69408
<br /> 11.Total 12.Unit 13,Waste Codes
<br /> 775-5T5-278U 10.Containers Quantity WLNoI.
<br /> Facility's Phone: Name,Hazard Class,ID Number, No Type -Bm
<br /> 9a 9b.U.S.DOT Description(including Proper Shipping
<br /> and Packing Group(if any))
<br /> HM F9f""
<br /> --�e1 ,ANIC,
<br /> o DM 180 P
<br /> DOW 362
<br /> Z A 2. RQ,UN1325,WASTE pLp,MMABLE SOLIDS,ORGANIC,N•O.S.,4.1,
<br /> PC311,POLYESTER ABSORBENTS WITH ACETONE G D001 Fqp3 214
<br /> 3, RQ,UN1993,WASTE FLAMMABLE LIQUIDS,NK,05 3,PGII, 7 �, 3<,s
<br /> N,o, �- d
<br /> ACETONE,PAINT
<br /> 4. RQ,1M1283,WASTE PAINT RELATED MATERIAL,3,PGII
<br /> 14.Special Handling Instructions and Additional Information
<br /> e�_��pyE-y�O.E{Z�.#�64 2.958782-04 ACETEON RAGS ER(.�133 3
<br /> 1_}� .958Tf31-05 PAINT,ACETONE ERG�"12
<br /> 4.PROFIL.E#1838e93-00 THINNER ERGO 128
<br /> EMERGENCY CONTACT:JESSE
<br /> n proper condition for transport according to applicable International and national governmen
<br /> marked and labeledlplacarded,and are in all respects ti
<br /> 15. GENE RATOR'SIOFFEROR'SCERTIF ICATION:Thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,
<br /> tal regulations.If export shipment and I am the Primary
<br /> and are classified,packaged,
<br /> p p
<br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. a� at
<br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or )(if I am a small quantity generator)is true.
<br /> Generator s/0" is Pr ntedliyped Name -
<br /> ❑Export from U.S. Port of entry/exit: _
<br /> 16.International Shipments Import to U.S. Date leaving U.S.:
<br /> Z Transporter signature(for exports only):
<br /> W 17.Transporter Acknowledgment of Receipt of Materials Month Day Year
<br /> LU
<br /> Sig atyre r � E `�
<br /> Tran 1 PrintedlT ped Name
<br /> a C1�� S�n Lure Month qDay Year
<br /> Z ra sp er 2 PdntedR e 9 x L
<br /> 18.DI repancy
<br /> 18a.Discrepancy Indication Space Quantity
<br /> ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection
<br /> Manifest Reference Number
<br /> U.S EPA ID Numbel', tA
<br /> 18b.Alternate Facility(or Generator) �y -
<br /> p permits(s)
<br /> pp
<br /> has i,to ro riate
<br /> LL Facility's Phone: Pt I on Day Year
<br /> 18c.Signature of Alternate Facility(or Generator) tor, a
<br /> a this generator is shippi
<br /> Z
<br /> N19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems)
<br /> Lu I (
<br /> 1 -----_- — 2. Fif 1 -/ ) 3 4. l`1 j) 7' / 'f.�
<br /> 20.Designated Facility Owner or Operator:Certificati,n f receipt of hazardous materials/covered by the manifest except as noted in Item 18a
<br /> Pri�l\Typed Narne Sign lure Month Day
<br /> 33 Year
<br /> EPA Form 8700-22(Rev.12 7) Previous editions are obsolete. P SI NATED FACILITY TO GENERATOR
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