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Please Drint or Noe (Form desioned for use on elite (12 -pitch) tvoewnter l <br />FormAoomved. OMR No 20SaM'{q <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete GENERATOR'S INITIAL COPY <br />UNIFORM HAZARDOUS <br />1 Ge erator D Number <br />I L C.YJ � `i 5 `i <br />2 Page 1 of <br />3 Emergency Response Phone <br />4. ManHast Trackinumber <br />10124180962 JJ K <br />WASTE MANIFEST <br />('�i ' <br />6— <br />5. Generator's Name and Mailing Address j y^ GeneraWs $0 Address i if dAferent than ma ling address' <br />r ( r r <br />l3weerato a Phone: . Sl ¢ 1 <br />6.Transporter 1C npartyNarne <br />U.S EPA 0Number <br />SACRAMENTO WASTE OIL <br />7. Transporter 2 Company Name <br />U.S EPA 10 Number <br />B. Designated Facility Name and Site Address <br />U.S. FPA ID Number <br />21st CENTURY ENVIROUPtENTAL MANAbF,t MT OF NEVADA, LLC <br />2795 NFWL-ANDS DR. FST FERNLEY, NY 9E408 <br />ri'ry 960 6y5 Sats <br />Facmlys Phone 775-525-2760 <br />9a <br />9b. U S DOT Description (nclt m Proper Shipping Name. Hazard Class. ID Number <br />10 Containers <br />11 Total <br />12 Unit <br />13 Waste Codes <br />No <br />Type <br />HM <br />and Pa�^g Group 8any)) <br />QuantityWlNol <br />1 <br />o <br />'iON—RCRA HAZARDOUS WASTE SOLIDS <br />( OIL SOLIDS <br />z <br />LLJ <br />c� <br />2 <br />3 <br />4 <br />14 Special Handing nstructions and Addition Irrtorrthabon <br />HANDLERS TO BE TRAINED AND USE PPE <br />ERG 0 12$ PROMI <br />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 <br />marked and tabeledlplapakd and are In al respects in proper condition for transport according to applicable international and national governmental regulations ti export shipment and I am the Primary <br />Expofter, l certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I certify that the waste minimization stalernent Identified In 40 CFR 262.27(x) (d I am a large quantity generator) or (b) (d I am a small quantity generator) is true <br />GeneratorslORemes PdntedlTyped Name Signature <br />Month Day Year <br />1= <br />16. tntemational Shipments <br />❑ Import to U.S ❑ Export horn U.S Port of entrylexit <br />LE <br />Transporter signature (for exports only) Date leaving U.S.: <br />W <br />17. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 PnnledfTyped Name Signature <br />Mordtr Day Year <br />Q <br />Transporter 2Prnikd--ypedName Signature <br />Mach Day Yaw <br />16. Discrepancy <br />16a. Dacrepancy ird.---ation Space ❑ o..tity ❑ Type ❑ Residue <br />❑ Partial Rejection <br />❑ Full Re)ectian <br />Manifest Reference Number. <br />18b. Alternate Fa -!&o (or Gererator} <br />U.S. EPA ID Number <br />J_ <br />L) <br />Fadlitys Phone <br />M <br />1& Signature of Alienate Factity (or Generator) <br />Month Day Year <br />Q <br />z <br />N19. <br />Hazardous Waste Report Management Method Codes fie codes for hazardous waste treatment. disposal, and recycling systems) <br />0 <br />1. <br />1 2 <br />3 <br />4. <br />20. Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Nem 18a <br />Puntedrryped Name Signature <br />Month Day Year <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete GENERATOR'S INITIAL COPY <br />