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06 / 11 / 2021 1 : 35 PM FAX 2099488625 AMCE SAW 0001 / 0007
<br /> Please print 4f kype. I PIP Form Approved, OMB No. 2050.0039
<br /> UNIFORM HAZARDOUS 1 , lleneralcr ID Number : 12. Page 1 of 3, Emergency Response Phone a, Manifest `ihohling Number X11 {�
<br /> WASTE MANIFEST CALU00 '17W38 ! SUU-74 7 0 218 �e � 4a '`t � � + �
<br /> 8, Generetora Name and Mailing Address Generators Sita Atldress (If different han mailing address)
<br /> ACME SAW '
<br /> 'iwkE MAIN 51'
<br /> STOCKTON ) C.A 95205 •
<br /> Generaicrs Phon104N9 &6735-
<br /> 6. ran9porter 1 Company Name U.S. EPA IO Number
<br /> AMMIC>AN VALLEY WASTE OIL, INC, CAR00027
<br /> 7, Trenaportsr 2 Company Name U.S. EPA ID Number
<br /> b`TERICYC2LE SPECIALTY WASTE SOLUTIONS, INC MNS0001 10024 •
<br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number
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<br /> gEw9AW* ..rx r#0VkLLC. _ .:. . .� ... .• - -. .. _ .__ .. _ . L�Af r8f1R8�i7 3' : .
<br /> tt 1855 VVHITE ROCK RU.
<br /> WCI 10 Ct)RDOVA, CA 85742
<br /> Farah .sPhon�1tr351^GN8I)
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<br /> ga 9b, U,S, DOT description (including ,Praper Shipping Nanie, Hazard Class, ID Number, 10, Containers 11 . Total 12. Unit 13, Waste Codes
<br /> HM and Packing Group (if any)) No. Type Quardity Wtivol,
<br /> 1 . i D01 DU16 ' 331
<br /> PIPX ROI, UNNIM 1r�A s FIAitAAIIARI I IN PIP, PIPE I ItIPIN I1I. cPIPt, , I IN PPIP I SI [ 1 5 �3
<br /> • PIP PGASOLINE, 01L
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<br /> 1, . . . . 14, $peelk Handling Instruction andAdd'itiors i-iAlowtioo_ . ,.. :. .. : . ._ . •... _ , ... ._ _ _ . ...__ . : _ IN ,. .,.. ..• . .. . ... . . . . .. . .
<br /> PROFILE# 46857�05 GAS, Oil" ERGO 128
<br /> Ik EMERGENCY CONTACT, MARY
<br /> i 1S, GENERATOR'StOFFEROR'S CERTIFICATiDN: thereby declare that the Men of this conaignment are fully and accurately described above by the proper shipping name, and are classified, packaged,
<br /> marked and labeledlplaearded, and are in ail respects in proper condition for transport according to applicable intemationalarid national govemmantel regulations.11 export shipment and t arri the•Primary ,
<br /> Exporter, l Cert$y that the contents of this consignment conformto iha tBntls•of the attached EPAAdtnowledgment of Consent.
<br /> > I certify that,the waste minimization statement Identtfled in 40 CFR 262.27(8) (f I am a•large quentity generator) (b) (it] am a small want ly genetajdj) is true.
<br /> slofferors Prid adliypcd Na ,, Sigiiahu Mo Day ' Y'
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<br /> '16. International Shipment �j
<br /> ® Import to U.S. ❑ Export from U,$, . Port of en cxiL'
<br /> h FROM
<br /> Transporter signature (for exports only) Date leaving U.S.:
<br /> ix' 17. Transporter Acknowledgment Of Receipt ofMeterials hionlh . day ear . ; f
<br /> Tran 20
<br /> r Pre tedlT d Name = y
<br /> 117/1 p VVIV id
<br /> M PITTra Pn ypad NarrrePIP
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<br /> 10, Discrepancy 0 n
<br /> L . . .• 18a, .DiscrBpancylndication Space • . � IN N, IDType — Reatdue• ....— . _ . • _.. . 0•P-siial Rejection IN ❑ Full I Ojecllon
<br /> Manifest Reference Number.
<br /> j 1 18b. Alternate Facility (or Generator) U:S. EPA ID Number
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<br /> U< Facility's Phone:
<br /> p. W 18c. Signature ofAltemata Facility (or Generator) Month Day Year
<br /> 19, Hazardous Waste Report Management Method Godes (i.e., codes for hazardous waste treatment, disposal, and recycling system)'
<br /> LLt1 , 2, 3. 4,
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<br /> PAN
<br /> 20, Designated Facility Omer or Operator; Certification of receipt of hazardous m�ferials co49red liy. ihe men'desEeictiapE§i3'iid0 in Item lea ,
<br /> Prints ac amsp ,p �� Signa Month DAy Year
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<br /> EPA Form 8700.22 (Rev. 12-17 • Previous editions are obsolete, IDESIGNATED FACILITY V GENERATOR
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