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Please print or type. Form Approved. OMB No. 2050-0039 <br /> UNIFORM HA7AROOUS 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4, Manifest Tracking Number �'+ p <br /> WASTE MANIFEST 1t1 I 2 b! LI G BF <br /> 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br /> YOSEME AVE ARCS AM IPM <br /> 1711 E. YOSEMITE AVE <br /> Generator's Phon � nr > <br /> 6. Transporter 1 CompanymName U.S. EPA ID Number <br /> AMERICALEY WASTE OIL , INNS: . CAR000272302 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 51ERic4* YC)LE SPECIALTY WASTE LLtN1 S, IW NSI 10924 <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> 2151 L'EN5ILIRY ENVIRONMINtAL MMMT CJI' INEVA,L'176, LL€: <br /> 2090 NEWLAN05 nR . EAST <br /> FI TtNLEY, NV 69408 <br /> Facility's Phond *75�575.2700 <br /> ga, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit <br /> HM <br /> and Packing Group (H any)) No. Type Quantity WWoI. 13. Waste Codes <br /> 1 ' DOI8 352 <br /> o IAC, PNA'�077 . I-I�AI?t`1C7t15 ►AtAS`fF SOLID , N40 , Er, Pcilll , (�A.�t�Lltdly i C1�r1 11�i P <br /> DIFSPL PtJMP FILTERS ev. IOSES , BEhN VNE <br /> Z 2. <br /> LU <br /> 3. <br /> 4. <br /> NV <br /> i i (.W s4 lfr .i : s l ; _17 <br /> 14. Special Handling Instructions and Additional Information <br /> PR011LE# 13;iW5� UU ABSORBENT , HOSE6 , 0M E: I#t:-a# III <br /> EMERGE ,Y CO NTAC"I : JASRIR <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 labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary <br /> Exporter, 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 statement idenfified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (di am a small quantity generator) is We. <br /> GeneratotslOfferoes Printed/Typed Name Signahtr . Month Day Year <br /> h r <br /> J 16. horn ' 6al Shipments, i <br /> El Import to U.S. ❑ Export from U,S. Port of entry/exit <br /> Z Transporter signature (for exports only): Dale leaving U.S.: <br /> LL' 17. TransporterAcknWMedgment of Receipt of Materia <br /> Transporte717ty d N a Signature • Month 0 Year <br /> � .... _. <br /> CIO <br /> Tran spo Ptd e Signature onth Day ear <br /> jr <br /> 18. Discrepancy <br /> 18a. Discrepancy indication Space ❑ Ouantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 18b, Alternate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> U <br /> LL Facility s Phone: <br /> W 18c. Signature of Altemate Facility (or Generator) Month Day Year <br /> Q <br /> z <br /> y19. Hazardous Waste Report Management Method Codes (i.e. , codes for hazardous waste treatment, disposal, and recycling systems) <br /> n 1 . 2, 3, Notice : State of California requires <br /> generator to photocopy and mail to <br /> 20. Designated Facility Owner or Operator. Cert fication of receipt of hazardous materials covered by the manifest except as noted in Item 18a ®T$C with 30 days4 <br /> Printedrryped Name Signature <br /> P . 0 Box 400 <br /> Sacramento,EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete, NeRATOR'S INITIAL COPY <br />