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:::.::_:...._....N...R. v. ......,HM. Form Approved.OMB No.2050-0039 <br /> 9 <br /> Please print lyp 4.Manifest Tracking Number <br /> UNIF=MANIFEST <br /> 1.Generator ID Number 2.Pae 1 of 3.Emergency Response Phone 021824316 JJ K <br /> WCAL000272020 1 209-329-5481 <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> CANEPA'S CAR WASH PACIFIC <br /> 6230 PACIFIC AVE <br /> STOCKTON,CA 95205 <br /> Generators Phong.09-329-0487 U.S. :PAID Number <br /> 6,Transporter 1 Company Name CAR000272302 <br /> AMERICAN VALLEY WASTE OIL, INC. <br /> U.S.EPA ID Number <br /> 7,Transporter 2 Company Name MNS000110924 <br /> STERICYCLE SPECIALTY WASTE E SOLUTIONS,INC <br /> U.S.EPA ID Number <br /> 8,Designated Facility Name and Site Address GE RANCHO GORDOVA, LLC, CAD980884183 <br /> 11855 WHITE ROCK RD. <br /> RANCHO CORDOVA,CA 85742 <br /> 916-3'51-098U <br /> Fadlity s Phone. <br /> 9b.U.S.DOT Descriptio(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> 9a. and Packing Group(if any)) No. Type Quant ty Wt.NoI. <br /> HM D001 D018 331 <br /> X 1. RQ UN1268,WASTE PETROLEUM DISTILLATES,N.O.S.,3,Pili, DM 65 <br /> GASOLINE,DIESEL <br /> z 2. <br /> W <br /> 3. <br /> 4. <br /> i <br /> i <br /> 14.Special Handling Instructions d Additional Information <br /> PROFILE# I C9?SjQ3(�' (Z WATER GAS ERG#128 <br /> EMERGENCY CONTACT:MARTY <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION:Thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassified,packaged, <br /> marked and labelediplacarded,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 EPAAcknowledgment 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)(III am a small quantity generator)is we. Month Day Year <br /> Signature <br /> Generator'slQflerorS Printed/Typed Name <br /> 16. ntemational Shipments Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ZDate leaving U.S.: <br /> Transporter signature(for exports only): <br /> fY 17.Transporter Acknowledgment of Receipt of Materials r Monti Day Year <br /> Lij12 Transporter 1 Printed ype Name Signature C(r <br /> O <br /> W natur Month Oay Year <br /> Z Transpo er 2 Pdnled(Typed Name ? p� <br /> 18.Discrepancy <br /> T FI Residue ElPartialRejection ❑Full Rejection <br /> 18a.Discrepancy Indication Space El Quantity El Type <br /> Manifest Reference Number: <br /> U.S.EPA ID Number <br /> 18b,Alternate Facility(cr Generator) <br /> r <br /> V <br /> ;a Facility's Phone: Month Day Year <br /> w t8c.Signature otAltemate Facility(or Generator) <br /> B <br /> Z <br /> 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4 <br /> W 1 2 3. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Month Day Year <br /> S g lure l� <br /> Printed/Typed Name IQ � <br /> fe ��'N <br /> PkIC1AT(WD CACILI CY L"( <br /> EPA Form 8700-22(Rev. 7) Previous editions are obsolete. 'C �( IFFS SYSTEM <br />