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06 / 11 / 2021 1430 PM FAX 2009488625 AMCE SAW 0001 / 0008
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<br /> Form Approved, OMB No, 205HO39
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<br /> UNIFORM•HAZARDOUS 1 . Generator ID Number 2. Page 1 of P. Emergenoy IN Response Phone 4. Manifest Tracking Number
<br /> WASTE MANIFEST CA1.f� 0178 t I l4&74'49 • � I � Q e . .� G B F
<br /> . Generators Name'and Malting Address Generators Site Address (If different than mailing ,address) •
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<br /> " 1204 S MAIN ST
<br /> NIP
<br /> STOCKTON , CA 05205
<br /> Genererore Phon�a'�8"�'?310&
<br /> 6, Transporter 1 Company Mama U.S. EPA pD Number
<br /> AMIERICAN VALLEY WASTE OIL , ING. CAROW272302
<br /> 7, Transporter 2 Company Name U,8. EPA ID Number
<br /> # STERICYCLE SPECIALTY WASTE SOLUTIONS, INC No
<br /> NIP 8. Designated Facility Name and $ite Address U.$, EPA ID Number
<br /> GEMwR40&l0 CORWVA, LLO: „ . . . IN 1 11 1
<br /> RANCf'tC! s,`ONDOVA, CA 95742
<br /> Fadli 's lS"5"a1-098Q
<br /> ga• 9b, U,$, OCT Description (including Propar Shipping Name, Heard Class, D Number, 10. Containers 11. Total 12. Unit 1$, Waste Codes
<br /> HM and:PackingGroup (it any)) No. Type Quantity WtNol,
<br /> x 1 .
<br /> PRO, t.1N1993 , WASTE FLAMMABLE LlWiE , N.O.S- ,3, poll , 1 DPA 55 O DWI 13018 331
<br /> GASOLINE, OIL
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<br /> Special Handling Instructions end Add'dfonal Information
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<br /> EMERGENCY CpiV'iAPOT, MARY
<br /> 15: GENERATOR'SIOFFEROR'S CERTIFICATION: I`heraby declare dint the oW,' tenta of ihlg cor(sU*4nt are tullyWsid accurately described abova;by the proper shipping name; and ireida901M,packaged,
<br /> ' marked and labeledlpiaoaroed, and are Ina0 respects in proper r onditi ri for Uansport eccoii)I'ng.to applloabfetntemeffonal and national govemmental ,regulations. If export shfpmenta6d I 'am the Primary ' : :' • .
<br /> Exporter, I certif .thetths contents of this ocnalgnment conform• to the terms of the Attached EPAAcknowiedgment Consent ¢. •. '
<br /> I cerin that itie.waste tnlnimnuon statement idorl0riod in 4O CFR 262.27(a) (f i am a lenge quantity generator) ar ) f am a small pnilty generator) Istwo: IN
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<br /> enerator rotgRontedjfy% ;NslrJgr Signatory - Month. . .. 'Day.,' 'Yea , ,11 11 ,
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<br /> 16i Intematiana, Shipments l�t
<br /> F import ta;Us. : Eshporf jyo(n 11.S. fort otenityloxib• Is I
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<br /> ?.,- 1Srans adorns riehxe ' [ek rta'oni ' bete leaving UPS,: :r :' T
<br /> ae 17. TransporWAaknoWedgmenf of ReMptof.Materiats
<br /> Transpo n 1Ind Name a Signature • Mant Day Year
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<br /> z 'frdllsporler n ypsd Na F ' c.P IN Now
<br /> �rmtu Month y Year
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<br /> 18. Discrepancy r
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<br /> 188,.Distrepantyintlica6onSpace _Iluantity_,. . . .. ;. _., ., _ .� . . � :Partlai•Rejaation•. •:. :- ,. � Pu1hReJepnon -
<br /> IN ON .. _ 1144:, 119. ._1. _...:. _. : ._.�__ , .. , ..L. ( Type . . ., . . . :.. . ._, ., .: Residue .,�, N., ..
<br /> ManllOstReferance Numbsc
<br /> 18b. Alternate Facility (arGenerator) U.S. EPA ID Number
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<br /> 4.• EaCBityS'Phone:
<br /> 5 1,90: %nalure ofAiternato Facility (or Generator) MonOi Day . , Year
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<br /> M, 19:Hazerdou's.Wsafe Repnrt•Manopment Metfrod Codes,{i.e„ •codes,fpXhata does wi de treatinent, disPgsalr and`rr3cyttin ” " '
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<br /> IN 20oloo, . Designated Facility Owner.or Operator. Cerdflostton11 1p'f receiDl of hazardaus materials covered by tha tnanifest oxcaptes nded'in Item 18s
<br /> printsdlimgName Signature41
<br /> �! Month Day , Year
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<br /> EPA Form 6700o22 (Rev. 1217) Previous editions are obsolete;: ,'. ' : t DESIGNATED FACII:I PYTO GENERATOR
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