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Please print or type._ : Form Approved OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Numher 2.Page 1 of 3.Emergency Response Phone' 4.Manifest Tracking Number <br /> WASTE MANIFEST CACA029;it 1133 I 209-404-7321 OR21. 2 GBF <br /> 5,Generator's Name and Meiling Address - Generator's Site Address(it different than mailing address) <br /> STANI ELECTM MOTOR <br /> 1520 E MIME. <br /> Mli 0A 95205 <br /> Generator's Phon¢?0l7-•+1+4 3'g1 <br /> 6,Transporter 1 Company Name U.S.EPAIDNumber <br /> . . ; AME.-RICAN VALLEY sF#66554•s OIL,INC. CARI)DY272:343'2 _ <br /> 7.Transporter 2 Company Name - - U.S.EPA ID Number - <br /> -. 5i[F tICY&LIE SPECIALTY WA;rii `u!,iLrYtit A$,INC; MN"SOUOI90D24 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> __-... <br /> 2m aiNnufix C:tdY RoNPAEw l<Mt3i'Yl IL OF NF'yIAE)A;S.f.0. <br /> 209-5 NIMLANOS RN,F.a,:"T INVIV808W438 <br /> Facilitys Phone:7T'''-«+"nli-c so -.. . <br /> 9a.. go.U.S.DOT Description(Including Proper Shipping Name,Hazard Class ID Number, 10 Containers 11.Total 12.Unit 13.Waste Codes <br /> BM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> X 1. Rid,�1A3tbT,',WAft3JOUS WX';"fE SIOLID,hi.Ct.S.,9,P001,LFAfO, i 0Y4. .. 640 P DOW 0008 - 181 <br /> 4Ii ICMIt9RJ1 <br /> Z._.. 2. <br /> w. - <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information - - - - - <br /> PiFY0FIuF# 838821.03 f,3E:At1BLA"TWir Ml "fALa EP:rs*M <br /> EA:tERGENCY GCNdTAr I': 13r4ACII: v <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION;i hereby declare that the contents of bible consignment are fully and accurately described above by the proper shipping name and are classified,packaged, <br /> marked and Iabeledlplacarded,and are In all respects In proper condition for transport according to applicableInternational antl national governmental regulations,If export shipment and I am the Primary <br /> -'Exporter,t notify that the contents.of this consignment conform to the terms of the attached EPAAcknowledgment of ConsanC- <br /> I certify that the waste minimization statement identified in 40 CFR 262:27(a)(If I am a large quantity generator)or @)(ifl am a small quantity generator)is true. <br /> GeneratorslOfferoes Pnntedfryped Name jj Signature - Month Day Yer . <br /> !fir.. <br /> 16.International Shipments - -^ - - <br /> I-- — I 1 ❑Import to U.S. ❑Export from U.S. Port of entrylexl •- <br /> Z Transporter signature(for exports only):' Date leaving U.S.: <br /> w 17 Transporter Acknowledgment of Receipt of Materials <br /> K Transpor 1 PnntedlT ped Name Sig/n§t re b""'� r �+' Month Day-. Year <br /> a r✓ I V "s f vyyf 4f/j <br /> aTransporter 2 Printedrryped Name _ Signature - Month DayYear - <br /> F- <br /> 18.Discrapancy . . . <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑T e <br /> Type ❑Residue ❑Partlal Rejection ❑Full Reaction <br /> Manifest Reference.Number:. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL <br /> Facility's Phone: <br /> aw Inc.Signature of Alternate Faciiity(or Generator) " - Month Day Year <br /> z <br /> N11-lazamous Waste Report Management Method Codes(I e,,odes,for hazardous waste Irani,em,disposal,and recycling systems) <br /> 0 1:-, ' 2 3. Notice: State of California requires <br /> generator to photocopy and mail to <br /> 20 Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted In item 18a DTSC With 30 days;... - <br /> Pnntedffypeb Name Signature - <br /> P.0 Box 400 <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete - Sacramento, CA 95812-0400 - <br /> GENERATUR'S INITIAL GUPT <br />