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- 7 <br /> Please print qrtype. Form Approved.OMB No.2050-0039 <br /> 79IFORM HAZARDOUS I Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAROW2821- I d_ 209.862-49M 0061A9224 G B F <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than malting address) <br /> PREMIER FINISHM <br /> 7910 S LONGEST. <br /> Generators Pho STOCKTON.CA 95206 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ?AMERICAN VALLEY *?HASTE OIL, INC. CAROW212302 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> STERICYCLE SPECIALTY WASTE SOLUTIONS, INCMNS00011Ill <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 21 ST CENTURY ENMRONMENTAL MGMT OF NEVADA,LLC 0dVD980895338 <br /> 211 NEWLANDS DR, EAST <br /> FERNLEY,NV 88408 <br /> Facility's phone/75-576-2760 <br /> 9a. 9b.U S-DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group{if any}) No. Type Quantity Wt.IVol. <br /> i\ 1 <br /> Ril NA3077,HAZARDOUS WASTE SOLID,N.O.S.,9,PGIII,LEAD, P D007 D008 j 181 <br /> CHROMIUMLu <br /> 1 <br /> tr <br /> t� . 2. RQ, NA3077,F+A MDOUS WASTE SOLID,N.O.S.,9, PGIII. 1 P D007 Di 181 } <br /> CHROMIUM,LEAD <br /> 3S2 <br /> 3. IVA3082, INAZARDOUS WASTE LIQUID,N.O.S.,9,PGIII, f LMA 55 G 343 <br /> N-METHYL-2-PYRROU DONE, EFITANOL,2-ANMWO-9 <br /> 4. NON-RCRA HAZARDOUS WASTE LIQUID,WATFRT3 NE PAINT, 4 DM 2.20 G 461 <br /> HYDROPURGEAi <br /> 14.Special Handling lnstructions and Additional Information l `l <br /> 1. PROFILE# 110515(1-00 ME1AL SHANII+IGS k.RG111111V71 2.PROFILE#102526-00 SANDING DUST ER(W 171 <br /> 3, PROFILE#W8418-00 JEM STRIP ERG 171 `�.PROFILE#986858-00 WATER 13ASE CLEANER ERGO 171 <br /> EMERGENCY CONTACT: CHRIS `f ` <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€abeledlplacarded,and are in all respects in proper condition for.transpert according Io applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 GFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is Irue. <br /> Generator'slOfferor's Printedffyped Name Signature Month Day Year <br /> _j 16.International Shipments <br /> H ❑Impart to U.S. ❑Export from U.S. Port of entrylexiC <br /> ? Transporter signalure(for exports only): Date leaving U.S.: <br /> reel 17.Transporter Acknowledgment of Receipt of Materials <br /> Transpc intedfT d Name Sign Month Day Yo r <br /> O <br /> Z Tralspo ker 2 intA/Typedv are ignature onth �]DaQy as <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: 21St GEM Of Nevada <br /> 18b.Alternate Faciiiry(or Generator) has theVpp6poi4te perm11 S s <br /> for, and will accept the waste <br /> Facility's Phone: <br /> rthis 613pi is shipping. <br /> 1 Bc.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> U2 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> a 1 2. � 3.� 1 1 4. 1 <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> PrintedlTyped Name f I r Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOR <br />