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KID <br /> 'I�tYPe. Form Approved. OMB No. 2050-0039 <br /> TUNIFORM HAZARDOUS 1. (kenemlor lD Number 2. pagelof 3. EmergencyResponse Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST CAL000266266 209-549-5612 006239755 G B F <br /> Generamfs Name and Mafiiaf)Address Generators Site Address (it different than maliing address) <br /> H&M MARKET BW#98 <br /> 531 MCHENRYAVE 2501 E. JACKSON <br /> MODESTO, CA 95354 ESCALON, CA 95320 <br /> Genemlors Phooa09-549-5612-105 <br /> 6, Trarepee, iCompany Name U.S. EPA IO Number <br /> AMERICAN VALLEY WASTE OIL, IN 9 CAR000272302 <br /> 7, Transporter 2 Company Name U.S. EPAIDNUmber <br /> STERICYCLE SPECIALTY WASTES )LOTIONS, INC MNS000110924 <br /> B. Oes0.7nalad Facility Name and 11,AddressU.S. EPA ID Number <br /> 2151- CENTURY ENVIRONMENTAL MGMT OF NEVADA,LLC NUD980895338 <br /> 2085 NEWLANDS DR. EAST <br /> FERNLEY, NV 89408 <br /> Faagiys Phone775-575-2760 <br /> 9a, <br /> 91b, US. DOT Description (Inducing Proper Shipping Name, Heard Class, ID No bey1g.Contelnam 11. Tatal 12. Unit <br /> HM and Paddrq GmWrfany)) IN . Type Ouantily NAyypl, 13.Wasle Cedes <br /> 0 x l RQ, NA3077, HAZARDOUS WASTE SOLID, N.0.8.. , PGIII, GASOLINE 1 OM 190 P D018 352 <br /> & DIESEL PUMP FILTERS & HOSES, BENZENE <br /> 2. <br /> If <br /> 3. <br /> 4. <br /> 14. Special Handling Inshuctions OdA dillonal infamauon <br /> PROFILE# 790729-ft GAS =, HOSES, ABSORB ENT ERG$ 171 <br /> EMERGENCY CONTACT. MONICA <br /> -. GENERATOWSIOFFEROR'SCERTIFICATION: Iherebydedam umtOe conWnts ink consignment are luny and acamtaydescribed above by the pmpersh]pping name, and are damned, padwged, <br /> marked and Wbele Aacarded, and ere In all respects in proper condition to lmnspo taoccaft to appreabie lnlemagonaland national gwammental nuuntams. If export sNpment end] am N Primary <br /> Evader, Ioe*thatme contacts of this consignment cont to the terms of Dre al ached EPA AcinoMedgment of Consent <br /> I cedly(hat the waste connotation statement ldenefied N 40 CFR 262.27(a) (#I am i large quad"eoemlor) or(b) (Iflam asmail quamygenemtor) Is hue. <br /> GeneradedOfleoura PdnwdfTyped Name Signature Monty gay Year <br /> Mali Sill <br /> -a e, int Ona In <br /> 5 pmenls a 1® <br /> F ❑ Impod IU,S. ❑ Expodhom U.S. PMofeMry/exit <br /> ? Transpodersignalure (loraxporbaniy): <br /> Data leaving U.S.; <br /> W 12 17. 71ansporterAdawWoogmenkof Receipt ofMeledals <br /> Transpodwi dine _ Sipna Month Da y1her <br /> O <br /> Transpan 2 gnaWre Month rpyk yak <br /> 1 <br /> T18. 0kcrepancy <br /> 18a. Discrepancy Indication Space ❑ Guanu <br /> ty 0Type ❑ Residua ❑ Partial Rejection ❑ Fug Rejection <br /> iBb.Allemale Fadlity(wGenemtar Marled Reference Number. <br /> U.B. EPAID Number <br /> U <br /> s+a- Faciliys Phone: <br /> W tBe. SignWture viAllemme Way tor Genemlor) M Day Y r <br /> z <br /> N19, Haurdws;Wears Report Management Method Codes Q.e., codes for brummous ased treatment, disposal, and recycling sysWms) <br /> a 1 <br /> fill ' 2 3. 4. <br /> 20. Oeslgnatw Mary Gwner or 0perzmr. Ceraficama of receipt ofarardous maWdals eredby Nemanifesl icept as noted N Item 18a <br /> .II(. PAnIjrw aSynalu <br /> Monty Day Year <br /> n <br /> EPA Fo m e7G0- 2 (Rev. t2-i ravlous ediuons are obsolete. DESIGNATED FACILITY TO EPArs eaMANIFEST SYSTEM <br />