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2-V Please print or type. ER I . " 1�0111 II I IIIIIIIIIIIIIilllllllll Form Approved.OMB No.2050-0O39 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000392588 1 (677) 577—"669 015631810 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) O' Reilly Auto !=a=rts taaKLiiIIY Ptut-C- 'Farts-#;27316 4-1 76747257 3-32; NORTH TRACY BLVD 3 323 NORTH TRACY BLVD Generator's Phone: TRACY, CA 95376 TRACY, CA 95:376-1720 6.Transporter 1 Company Name U.S.EPA ID Number Clean Earth Specialty Waste Solutions MIS!5000111%1924 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address General Environmental Mgt, LLC U.S.EPA ID Number 1165.5 White mock Coad Rancho Cordova, CA 974 ' Facility's Phone9163510980 CAI)`38+ ,9841832 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. 5 , Waste eroso s, amm,5 e , ERG#126 1 CF 00018 P 214 'Ls001 �a w z 2. L I i 3. i s 4. 14.Special Handling Instructions and Additional Information 1 1 111016b-1,,'Al e r o s O I 5, Flammable 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,aryl are classified,packaged, marked and labeled/placarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if m a small quantity generator)is true. Ge er or's/Offeror's Printed/Typed Name Si at Month Day Year 16 ntemational Shipments I— ❑Import to U.S. Export from .S. Port of ry ? Transporter signature(for exports only): Date aving .S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name 1gnature Month Day Year a Anthony ruck QTransporter 2 Printed/Typed Name i nature Moontthh Day Year1 18.Discrepancy 18a.Discrepancy Indication Space Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: F 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V gar- Facility's Phone: C3 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1 2• 3. 4, 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name 1 Signature Month yD�ay Year VJ EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. D IGNATE 1LITY TO EPA's e-MANIFEST SYSTEM 8700--22 12Y3 I"AI._40000003 134t097317 042036581. ry! 1=D0311,31_;=`1 6 DO331 1