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'rll'w� pOtartyye. Folm Approved.OMB No.200.0039 <br /> V UNIFORMNAZARWU3 1.GarerebrlONumber 2.Pape1M 3.Enremed,Re ddaPMre N. I ' '$39 <br /> WASTE MANIFEST CAL000344637 1 209-403-7974 GBF <br /> Q5.GMadmra Name Wd Maping Mdr Wd Canradefs SNe Atldea(adRerenf Nen maNrgamreee) <br /> !'1 M&L REFRIGERATED <br /> 2323 PORT RD#A <br /> STOCKTON,CA 95205 <br /> Gedidene <br /> epale,I Cer 9-4D3-7974 <br /> i S.Tmnapateri Company Name U.S.EPAID Number <br /> AMERICAN VALLEY WASTE OIL,INC. CAR000272302 <br /> i.TmnsppMr2 Company Name U.S.EPAID Number <br /> STERICYCLE SPECIALTY WASTE SOLUTIONS,INC NHNS000110924 <br /> 8 Deagraded Facility Name ad SlMAtltlress US.EPA ID NunNer <br /> GEM-RANCHO CORDOVA,I.I.C. <br /> 11855 WHITE ROCK RD. CAD980884183 <br /> RANCHO CORDOVA,CA 95742 <br /> Face sPbme916-351-0980 <br /> Sea 96.U S.OOT DeaMpdM PndM'vm Pmpx ShipprG fare,Ha7aNCku,IDNumbm. 10.CMtarem <br /> II.Tani IN aMPadingGroup(ilany)) Np. iYPe Qtembly iWVJoI 13 Waste Gtlea <br /> X 1 <br /> RO,UN1263,WASTE PAINT,3, PGII 2 DM 110 G D001 FOW FOOS <br /> 214 <br /> 2. <br /> 3 <br /> 4. <br /> 11.&pedN HeMirp IrsVuctlpna antl AadSpral Intermitted, <br /> PROFILE#164975500 PAINT WASTE ERG#128 <br /> I EMERGENCY CONTACT:DANIEL <br /> 15. GENERATOR'SIOFFEMWSCERTIFICATION:Iberebyaadma Natble MM dWs Mnsignmemam NNyawacarabNaesv6eEabwebytlppm OlpON.a ,.Maretles w,padagea, <br /> moment and labelealplacaNea,aid are in all mspads in Ppperm,MNpn dandeaddelavordiN to appll®Ue'erMmakaNam maAmel gpremmeNel regOddeme.NeapMahipment antl l am N,a Pdmay <br /> Elmmler Ide"that NeoMMnkofNk MnRgnmemmnfam deft derma 01Ne MOW EPAAdnorlMgmenldfC Ml. <br /> 1ftrNytlulfe minim®Iden tlalmnmt nemNm In4a CFR 282.2i(e)INI amalege WanMY 9MaadeN alb)(alamasmMlqunlilygMaatpr)kmn. <br /> GenemklslORemis pha PrnMNfypM Name SgnaWre � M OSY Year <br /> L <br /> i6.IMemehprel Slip� <br /> manti, <br /> Trznspwmredmema(foreapMs oMy❑Inpodb u.s. aung USm <br /> ❑Evpalhum u.s lus' <br /> Oead, <br /> j 7.TnndaM�AdmdWWgM,dIRMpdd MaMN , M : <br /> rerepMer i PdnMdTyPed Name SgreWre <br /> ? Ly Mp m e2� Y e <br /> �a reyeetr 'll. pad Name n MMdb Oa Year <br /> S.Cixrepamy <br /> �_) Be.Dhmepa,wy lndiato Space ❑ Gerdy ❑TYpe ❑Rateidn ❑Pared ReM Gin ❑FJI RepcSon <br /> �I Bb.PlMrnde FatlNy la Ge,Mralar) MedMNANaer�Nunbr. <br /> U.S.EPAW NmMx <br /> a fli"11M1Me: <br /> &.5mnebue NAsamdaFWay lar Generalo') Mamb Day Year <br /> ;� �" 9.Hazartbla Wash RepMMeregamMMebatl Cptlea Tie,mtlmhba7adaiearesM treebnMt dspopl,ane <br /> rerytlir4 sysbnrs) <br /> W 2, 3. C <br /> .DaWreletl Fadky Om,erar OperePor:CaMratlpnNresptoi kmrerad b)Nt menifesle�ptasrMetl in lMm iSa <br /> ylaed Name T N Day Year <br /> Farm 870422(Rev.12-17) Prevuus e#tions ero abeolela. DESIGNATED FACHM TO EPA's ch-MANIFEST SYSTEM <br />