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Form Approved. OM.© No. 2050-0038 <br />Ntease <br />pirtm or type. 'I-orm Gest neu for use un enln 1 sig 1 YLUM , r - <br />2 Pape I o! 3 Emergency Response Phone <br />A. ManHerst kftsg Nwibw <br />UNIFORM HAZARDOUS Genetaw ID Number <br />004822882 J J K <br />WASTE MANIFEST CALOOl _ 4 <br />5 Generaloes Name and Mating Address Generelor s SRe Address (N dAllawl dAn mal'ng address) <br />PROFLEET, INC. - L'OD) 15453 N. THORN ON ROAD <br />WWW ELKMONT W-A-'I�_- LODI, CA 45242 <br />ELK GROVE, CA >�4 <br />Oeneratces Phone209.333-8383 — i <br />U.S. EPA ID Number <br />6, Transporter I Company Nerve <br />FRE11AOM ENVIRONM SERVICES INC. Phone 0800-558.3274 <br />CAR000171017 .. <br />U.S EPA ID Number <br />7. Transporter 2 Company Name i <br />2181 CENTURY EWROWENTAL MANAGEMENT OF NEVADA, LLC <br />CAR0001W12 <br />8 Designated Fadilty Name and Sfle Address <br />218T.CENTURY I+ <br />US EPA ID Number <br />NVD980895338 <br />r ... QRNE, EAST <br />FERNLI?Y, M/ 8 <br />Fact s Phone: 776.675-2790 , <br />Be. <br />9b. U.S. DOT Desalpdon (hcwing Proper Shipping Name, Hazprd Class, ID Number, <br />10. Containers <br />11. Total <br />12. Urrt <br />13. Wade Codes <br />No. <br />Type <br />HM <br />and Pac^g G -p (d any)) <br />Quentity <br />M Not. <br />1 vWatrRCRA Haardous Waste, SoNd (Oily <br />sl <br />� <br />` 0 7 <br />U <br />DM <br />P <br />223 <br />-- <br />Qa <br />v <br />Lu <br />2Lu <br />-- -- <br />0 <br />— -- <br />- <br />3 <br />4 <br />14. Special Handing nslrudions and AdckWal Inlonration <br />Handlers to be 40hr trained and use PPE. <br />9b 1) 3 8 8 1 88-00 E <br />G A' 171 <br />tw Ina contents of ohs conslgnmenl ars filly and accurately described above by the proper shipping risme, ard are cbstslreO, packaged, <br />15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare <br />marked and Iebeledfplacardad, and are in all respects In proper coqdlion <br />for Iransporl accorQng to appacabie Internallonal and national govammental regulations It export sMpment and I am the Prinury <br />Exporter, I ced7y that the contents of this constgrinwi conform to <br />he terms of IIw attarirad FPA Acknowledgment of Consent <br />cerliy that 0-w waste mnimiizaton statement de fi6ed in 40 CFR <br />-62 71(0) (if ',am n w9e, pranfily genwakv) a (h) (if! am a vrwA nr Mty generator) is true <br />nefsW a Prirted7Typed Name G r <br />VV/V o / Signature <br />Month DayYear <br />.__�---- <br />IL <br />tM Jw— <br />in, <br />�_� Expod from U.S Port olentry/exk:..._-_- <br />I <br />---_— — ___ <br />16.Internalurtal Shitarnenis <br />Import to U.S <br />— <br />Transporter signature (for exports only): <br />Dole heaving U.S <br />17. TmaperterAdmM%ledynent of Reaelpl of Materials <br />T 1 Print ypexl Ne <br />IJ <br />6rMMXiNnW4y*Norm <br />S <br />th Day Year <br />Mont <br />10 I <br />Mcn11 Day Year <br />18.0knopl ncy <br />180-. Dlaaepancy Indication Space l l OuanGry <br />Ty, ❑ Rsakk e <br />❑ Pa tlel Refection Dull Rejection <br />Manihsi Reference Number. <br />18b. Altemale Facety (or Generator) <br />U.S. EPA ID Number <br />FadOysPhone: <br />1 lura o MaiF4a Fs ity (or rata) <br />Month ear <br />19. Hazardous VVasle Report Management Meelod Codes (i.e., codes ft f htzerdous waste treatment, dhposal, and recydhg systems) <br />1. �� <br />2. � <br />3 <br />a. <br />20. Desigruhd FaclkOmw or Operator: Cer"catlon of racslpt of a materials covered by the meNfest except as We'd n Item 1 &a <br />Prinled/Typed Name Signmrs <br />Month bK <br />EPA Form 8700-22 (Rev. 3.05) Previous editfons are obsolete DESIGNATED FACILI�)` TO DESTINATION STATE (IF REQUIRED) <br />