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;,, — r,— X— iaelnnad for use on aMe (12-000) NDefter l /,'or(- 4r -7 6,16 Form Approved. OKIB No, 2050-0038 <br />JNr V' 111 . -1- --_. <br />ORM HAZARDOUS <br />t _ Generate ID Number 2 Papa f of <br />3. Em:�mcy Reapcnse Phone <br />er <br />-- <br />4. tial Tracks n9 Num <br />004822580 JJK <br />WASTE MANIFEST <br />CALD6668 <br />0027 <br />•,mea Name and Mailing Address wm, Generetnre Sl%Address (Y 01%owt Cion m&IN eddess) <br />PRQFLEET, INC. - LODI 15453 N THORNTON ROAD <br />SM W000I T WAY LODI, CA 95242 <br />ELK GROVE, CA 86lS24 <br />Phos <br />7'ors <br />,gatsr 1 Company Ns rtr ll S EPA ID Numbs <br />FREMOUW ENVIRONMENTAL SERVICES INC. Phe # 600-55 3274 CARD00171017 <br />i. i rsnsporter 2 Company Name U.S. EPA ID Number <br />211t CENTURY EWR AL NW"EMEM OF NEVADA, LLC CMWOIW12 <br />- N .gnalad Fabtty Nance and Sne Addrm U.S. EPA ID Number <br />21ST C NTURY®tlfl NVD98OUS338 <br />20" DRTVE, EAST <br />FERwry, NV <br />Facial a mne:77W5-2M <br />ga <br />9b. U.S. DOT DeWiMw (nck&V Proper Shipprp Name, HWard Class. ID Number <br />10 CvT18 <br />11. TOW <br />12. Ur l <br />13. Waste Costes <br />No. <br />I Type <br />ItM <br />and Pad*bg Group (n any)) <br />ouaardly <br />WI.NO' . <br />' NON.RCRAHAZARDOUS WASTE, SOLID (OILY DEBRIS). <br />0f)3 <br />DM <br />j(0,90 <br />P <br />223 <br />2. <br />3. <br />I <br />4, <br />I a. HanclN IrWnxbons end Addftml Irdamatlon <br />FwlrWW* to be 4ft "kwd rtlt W use PPE. <br />Ob1)386166 .:%1 B X'55 ERG N 171 <br />OENMATORIWFe10R'S CERTIFICATION: I hereby Aedere that the conow is of Rrls conetgrmwl are futy and eccuratety described above by rhe Proper sblppkg name, erd an clwftd, packaged, <br />madnd wW Wbds&0K rdad, and aro In all real , In proper condltton for traneporl wmr*v to eppkshis Inlemetlarl and nadonel gmWrmental mgi/etbrre. If export Shipment and I am the Prknary <br />Enorhr I aerlOy Ihd M oorianb of this caulpmMrtt ovrfwm to (he lemu of** attached EPA Acb wtedgment of Conaant <br />csrMy Ihat Mr Meda nilYr isNon ahYrnaM kantlaed n IO CFR 28227(9) (N lam s large qAn ty 9wwv r) or (b) (If I em a amdl Quantity generator) istree. <br />Moft D" Yw <br />f—l" ITT:7 — <br />• knport to U S � Flxl tom U.S. Pod of entryre><n: -- ----- — - <br />- T (for lxportsorty). Date leaving U.S <br />Aoingal�tSN11 d ftcelpt of Msterfda Ak <br />YewQ <br />Month Day <br />114 .5L <br />, 1 ' l `Dmeq, w <br />V <br />V - - 1 <br />j, <br />118. fscrepancy <br />1 <br />itae. <br />Dieorepancy Indlaw space ❑ ❑ -ype ❑ RaNue ❑ Pwft R*cbw ❑ Full R.*wn <br />Menllest Refereoce Num <br />tab. Alannaie Fealty (a Generate) U.S. EPA ID Number <br />Faciltys Phone: <br />re of eh Faclity (a eretor) <br />more y ear <br />19. Hasardotw Wada Report Mang~ Methmi Coda 0.e., coda for hazardous waste "&tnwI, dbpoeal, awl tecydkp Systeme) <br />1. 2 9 1. <br />��l <br />X Oldiroled Fadaty Ow— a Opersgr CwdcAon of receipt of Mtardous mailer*, cowrad by era MNW =apt natal h ttern 1aa <br />PonWTVW Name Morm <br />Sn �� ba'y ►��-,� 11� I r� o <br />EPA Form 8700-22 (Rev. 3-M) Previous edlNns aro obsolete. <br />)?-15—O'1"A09:3O RCVD DESIGNATED FA ITY TO DESTINATION STATE IF REQUIP.ED) <br />