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rN ;� 2019 <br /> Please print or type Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 11-GerieratorOiNumber rp—age 1 of 3.Emergency Response Phone 4.Manifest Tracking Nurrfber <br /> WASTE MANIFEST CAR00028211 I ZOO-882-4" 006148459 G B F <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> PREMIER FINISHING <br /> 7910 S LONGE ST. <br /> f� STOCi' i6N,CA 8520fi f� Generators Phony-�'� -5585 <br /> 6-Transporter 1 Company Name U.S.EPA ID Number <br /> r' AMERICAN VALLEY WASTE OIL, INC CAR000272302 1 <br /> 7.Transporter 2 Company flame U.S.EPA Ip Number <br /> r. 1 TERICYCLE SPECIALTY WASTE SOLUTIONS, INC MNS000110924 <br /> B.Designated Facility Name and Site Address U.S-CPA 1D Number t <br /> GEIUI-iRAI+ICH()caRDOVA, LLC. <br /> 11855 WHITE BOCK Rd. :AD9aOA841a3 <br /> RA140M CORDOVA,CA 95742 <br /> Facilitys PhoneO16-351-OW <br /> ga 9b US.DOT Description{including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)} 13 Waste Codes <br /> No, Type Quantity Wt.Nol. <br /> 0 1. i*—W-RCRA HA7ARDI0 IS WASTE 1111011i WATER.()It A DERRI.S 0 343 <br /> w <br /> w 2. <br /> c� <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information It <br /> PK0FiLir#UUJJj695-(?(1 PRESSII iE WASHER WAfER EIRCO 171 <br /> EMERGENCY CONTACT:CRAIG <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION: 1 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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable Internationai and natlanal 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 EPA Acknowledgment of Consent. <br /> 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. <br /> Generatorsl0fferors PrintedfTyped Name Signature Month Day Year <br /> ZD <br /> J 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. , rt of entrylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> Ill 17.Transporter Acknowledgment of Receipt of Materials <br /> 7ranspor er;t gnyped me Signature Mepth Day Y r <br /> O O <br /> zTr pe r 2 PrintedfCyped Name Signature Mmi h Ory Ye <br /> 18.Discrepancy <br /> tea.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue <br /> ❑Partial Rejection ❑Ful!Rejocfion <br /> Manifest Reference Number: <br /> 18b.AAerna#e Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> w 18c.Signature cf Alternate Facility(or Generator) <br /> QMonth pay Year <br /> X <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codss for hazardous waste trea(ment,disposal,and recycling systems) <br /> LU <br /> 13 1 ��A 1 1 <br /> 2 3 <br /> 4. <br /> 2.0.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. <br /> DESIGNATED FACILITYTO GENERATOR' <br />