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2611 <br /> PleForm Approved. OMB No. 2050-0039 <br /> ase print or type. (Form designed for use on elite (12-pitch) typewriter:) <br /> UNIFORM HAZARDOUS 1 . Generator 10 Number 2, Page 1 of 3. Emergency Response Phone 4. Ma(ni�festTracckin Nuumbeer (� C <br /> WASTE MANIFEST CAL00035LI320 1 209 522-3271 V 02739094 `�' B r <br /> 5. Generator s Name and Mailing Address Pdw essi(i di ht`th m ling address) <br /> JM EQUIPMENT CO , - NlAN 1"ECA <br /> 321 SPRECKELSAVF_ <br /> MANTECA, CA 95336 <br /> Generator's Phone: 209-522-3271 -105 <br /> 1_ 6, Transporter 1 Company Name U.S. EPA ID Number <br /> AMERICAN VALLEY WASTE OIL, INC. CAL000827878 <br /> 7. Transporter 2 Company Name HEPTH npRAPTAnr_- nr,- <br /> .S. EPA ID Number <br /> FL <br /> j < <br /> J 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> 21ST CE14WRY ENVIRONMENTAL MGMT OF KNADA,L.LC NVD9.80895338 <br /> 2095 NEWLANDS DR . EAST <br /> r. FERNLEY, NV 89408FFF <br /> Facilitys Phone: 775-576-2760 A <br /> t ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit 13, Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity WLNoI. <br /> F1 ' NON RCRA HAZARDOUS WASTE SOLID 1 DCVI 335 P 223 3.52 <br /> of ABSORBENTS & OIL. <br /> i <br /> ' z 2. <br /> 1 <br /> i <br /> i <br /> 3. <br /> 40 FP <br /> l9 10 <br /> i . <br /> i <br /> 1 14. Special Handling Insa17 ns and dilional Information <br /> PROFILE# Q O17 <br /> APPROPRIA;f PROTECTIVE CLOTHING <br /> SEE ERG #8171 EMERGENCY CONTACT: MATT DAY <br /> ii <br /> 15. GENERATOR'SIOFFEROWS 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, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> II 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 /> Month <br /> ear Ft, <br /> Generator'slOfJeror's Printed/Typedi�ame •. Signature ' - Day N <br /> !ti <br /> i J <br /> � FFFFFFFF <br /> j 16. International Shipments "I <br /> ... ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: <br /> Z . Transporter signature (forexports _ _only): Date leaving U.S.: <br /> IF I- <br /> JulLW17 Transporter mentofRecer tofMaterials <br /> P 9 p Si natur <br /> R Transporter 1 Pdnted/f d Name r g e Month Day FFFF , <br /> O IF <br /> T <br /> I Q Xilml 45 Transporter 2 Printedffyped N 4 Signature 4 Month . Day Year <br /> 18:.Discrepancy _ . <br /> I " 1 18a. Discrepancy Indication Space ElQuantity ❑ Type ❑ Residue [:1 Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) INpVl UnR . CI . 0Cdf 0yeMetk4 JL(. U.S. EPA ID Number <br /> p);A r,(( Erivtl"0111 rr} a j fer vli e5 <br /> W FacilitysPhone: � � � rJ � � tY� �• Gfrlct3 o}r(. 1Ubpfa T$ 72 <br /> W 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> az � . . n _ <br /> 19. Hazardous Waste Report Management Method Codes(i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 0 1 . 2. 3. 4. <br /> 20, Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> - Pnnted/Typed Name Signature Month Day Year <br /> `i <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR <br />