Laserfiche WebLink
111ease p0nl .type. FuiuinApproved.OW No,20SU-0039 <br /> 09FFORM HAZARDOUS 1 Generator 0 Number 2.Page 13 Emergency Response Phone Al.Manifest Tracking Number <br /> WASTE'MANIFEST (;AFt6002E1;1 i • r i <br /> 211:1�>*):: 4k+tl':l 7 4 G B F <br /> 5 Genefalors Name and Mailing Address Generator's Silo Address(if different than mailing address) <br /> PREMIER FINISHMC <br /> 1810 8 LONGS ST, <br /> STOCKTON,CSA 85206 <br /> Ganeralol's Pho <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> AMERICAN VALLEY WASTE OIL, INC. CAROW2723W <br /> I.Transporter 2 Company Name U.S.EPA ID Number <br /> STERICYCLE SPECIALTY WASTE SOLUTIONS, INC M NS0001 10924 <br /> 8.Designated Facility Name and Silo Address U.S.EPA ID Number <br /> 21ST CENTURY EWRONMENTAL MGMT OF NEVADA.LLC NyppgO$D533B <br /> 2095 NEWLANDS DR EAST <br /> FERNLEY,NV 59408 <br /> Facility's Piione7 7"75-2780 <br /> ga. 9b.U.S.DOT Desariptfon(including Proper SNpping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> _ No, Type Quantity WGNof. <br /> X 1p R4,NV43p7T,HArTARDOUS WASTE SOLID,N.O.S.,P. PC3111,LEAD, I D007 D008 181 f-illh i��; r' <br /> t CMAIIJM <br /> Uj r 2. RQ, NA3077,HAZARDOUS WASTE SOLID,N.O-S.,9, PGIII, l Lim 155 P 111107 D1108 181 <br /> (A-IROMIUM, LEAD <br /> 362 <br /> s. NA3082,HAZARDOUS WASTE LIQUID,N.O.S.,G,POIII, 1 iMA 343 <br /> RT-METHYL-2-PYRROLIDONE, EHTANOL, 2-AMMWO.9 <br /> 4. N01+1-RCRA HAZARDOUS WASTE LICAAD;WAT/�Rmrb�NE PAINI, 4 DM 22,0 O 481 <br /> HYDROPURG117 <br /> i <br /> 14.Special Handling Instruclions and Additional blformation IJ <br /> I. PRUFILE0 111'b 15U-Oo METAL S�-tAVINGS �RCt�At 47� .PROFILE#102528-00 SANDING DUST ERCP#171 <br /> 3.PROFILE#888418-00 JFM STRIP ERI 1.1 I 4. PROFILV#986858-00 WATER BASE CLEANER ERCT#171 <br /> EMERGENCY CONTACT:CHRIS V <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare Ihal the contents of;ihlli.consignmenl_are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are In all respects in proper condition forflransp'grt acchrding to applicable inlernatiopal and national governmental regulations,If export shipment and I am the Pdmary <br /> Exporter,I codify that the contents of[his consignmenl conform to the(arms of the attached EPAAcknowledgmant of Consent. <br /> I certify that the waste minimization statement Idenlled In 40 CFR 262.27(a)(if I am a targe quantity generator)or(b)(it I am a small quantity generator)Is[rue <br /> Generalar'afOfferor's PrintedfTyped Name Slgnat re Month Day Year <br /> �f�1elS `kbfj ✓� I <br /> 16.International Shipments <br /> 1— ❑impart to U.S. ❑Export from U.S. Part of entrylexil: <br /> K Transporter signature(for exports only): Dale leaving U.S.: <br /> w 17,Transporter Acknowledgment of Receipt of MateOf s <br /> a Transpo nted T d Name Month Ray Ye r <br /> 4 <br /> M <br /> 2 Tr spa art mtedffypedJame ~"Stgnalure Doth Day Year <br /> �:l ! 08 1r. <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ quantity ❑Type <br /> ❑Residue ❑Parlial Rejection ❑Full Rejeclloh <br /> Manifest Reference Number. 21st CEM of Nevado <br /> 18b,Alternate Facility(or Generator) has the Ore perm) S s <br /> J <br /> for, and will accept the waste <br /> W Facility's Phone: Shippingthis lenpratne is <br /> L 18c.Signature olAlternate Facility(or Generator) Monlh Day Year <br /> Q <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous wasla treatment,disposal,and recycling systems) <br /> A 1. 2. 3. 4. <br /> Ill <br /> l <br /> �/-\ AT-A A <br /> 20.Designated Faclilty Owner or Operator.Certilicalion of recepl of hazardous materials covered by the manifest except as nded In Ilem 18a <br /> PdritedlTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editlons are obsolete. DESIGNATED FACILITY TO GENER�TOR <br />