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,,print or type.(Form designed for use on elite(12-pitch)typewriter.) 1 L�� Form Approved.OMB No.2050-0039 UNIFORM IIAZARDOIlS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number p WASTE MANIFEST CALOClf32o1 G D F 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) VE TERN SMIARE 1621 N BROADWAY STOCKTON,CA 95205 Generator's Phone::,' -94�4lF]2i 6 Transporter 1 Company Name - U.S.EPA ID Number AMERICM VALLEY WASTE OIL. 0,C. r.L. 7 Transporter 2 Company Name U.S.EPA ID Number 7 8.Designated Facility Name and Site Address +r U S.EPA ID Number :i ST CENTURY Et�1 HONIfIBEMTAL MGMT OF t&vAwj.f r; :iEif��JFrCr8fi633� 2095 TiEWLAND6 DR.EAST FERNLEY,li-i a24w E r�t75-2L Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit HM and Packing Group(if any)} No. Type Quantity wt./Vol. 13,Waste Codes �. 1. f'4014-RCRA!-IAZARUOLI,S WASTE SOLID - 362 ABSORBENT DIll OIL gel�� rz z. cs 3, f 4. t i 14.Special Handling Instructions and Additional Information y bIR ERG#-179 Sa i L. '-'-NTACT:LARRY 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby der,Iare that the contents of this consignmenf.are fuly and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacarded,and are in alt respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached FPAAcknowledgmsm of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator'slOfferor's PrintedlTyped Name Signature �� Month Day Year 16.International Shipments z ❑Import to U.S. ❑Expert from U.S. J Port of ori lexil: Transporter signature(far exports only): Date leaving U.S.: Ll 17.TransponerAcknowledgment of Receipt of Materials Transporter 1 PrintedlTyped Name Sigpature Month Day Year O a Q Transporter 2 PrintedlTyped Name Signature Month Day Year 18.Discrepancy 1 Ea.Discrepancy Indication Space ❑ Qufarrtity F1 Type Ll Residue ❑Partial Rejection ❑Full Rejection 21st C Manifest Reference Number: 18b.Alternate Facility(or Generate as the appropriate U.S.EPA ID Number P permi#s(s) Q dor,arld will accept the waste LL. Facility's Phone: w 1 Ec.Signature of Alternate Facility(or Generato Month Day Year I- Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) 0 1. 2. T3. 4. 20-Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. JAN 2 f 2 1 DESIGNAT,ED FACILITY TO GENERATOR