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200160534CLE 42376228 <br /> Please print or type. <br /> ERI Provider: Clean Earth Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Traddng Number <br /> WASTE MANIFEST CAL000282022 1 8775772669 200160534CLE <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different man mailing address) <br /> Autozone#3315 Autozone#3315 <br /> 1122 W 11Th St 1122 W 11Th St <br /> Tracy,CA 95376 Ph:2098324911 Tracy,CA 95376 Ph:2098324911 <br /> Generators Phone: <br /> 6.Transporter t Company Name U.S.EPA ID Number <br /> Clean Earth Specialty Waste Solutions MN24 <br /> SPAID umber <br /> 7.Transporter 2 Company Name U.S.EPAIDNumber <br /> 8.Designated Facility Name and Site Address - U.S.EPAID IDNumbNumber <br /> 21st Century EMN,LLC NVD9 38 <br /> 2095 Newlands Dr.East <br /> Fernley,NV 89408 <br /> Faalay's Phone: 7755752760 <br /> ga. 9b.US.DOT Description(mounting Proper Shipping Name,Hazard Unit Class,ID Number. 10.Containers tt.Total 12. <br /> i HM and Packing Group(it any)) No. Type Quantity W.Unit 13,Waste Codes <br /> O1 UIno <br /> N3262,Waste Corrosive solid,board,Inorganic,mo.s.(Sodium Carbonate,Lead), 8,PG 11, <br /> X ERG#154 181 D008 <br /> a~ i CF 00003 P <br /> W <br /> W2'UN1950,Waste Aerosols,[flammable,(each not exceeding 1 L capacity)]2.1,ERG#126 <br /> X 274 D001 3 0005 <br /> 1 CF 00037 P ---1 --.--1----_ ' <br /> 1 <br /> D007 D035 <br /> 3.UN1993,Waste Flammable liquids,mo.s.(Methyl Ethyl Nature,Xylene), 3,PG 11,ERG#128 <br /> 1 X 331 D001 D035 <br /> 1 CF 00025 P <br /> 4, <br /> 14.Spedal Handling Instructions and gddi[ional Information <br /> 1.110355(Soda Ash) 2.109926(Aeroscls) 3.109931(Flammable Liquids) <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged. <br /> marked and Iabelediplacanded,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 <br /> Exporter,I certify that me contents of this consignment conform to the terms of me attached EPA Acknowledgment of Consent. <br /> I cerbly that me waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(III(if I am a small quantity generator)is me. <br /> GeneratorslOfferor's PdnledfTFred Name - Signature Month Day Year <br /> Andrew Winkler(On Behalf of Auto Zone) 05 23 2022 <br /> 16.international Shipments <br /> i 11Importto U.S. LJ Export from U.S. Pon of entry/exit_ <br /> Transporter signature(for exports only)' Date leaving U.S.' <br /> IC 17.TransporterAcknowledgment of Receipt of Materials <br /> C Transporter 1 Proud;Typed Name Signature <br /> R Andrew Winkler Month Day ]�2 <br /> 05 23 <br /> = Transpprter2 PnnledRyped Name Signature <br /> Month Day <br /> E— <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ ❑Quantity ❑Type Residue ❑Partial Rejection <br /> ❑Full Rejection <br /> lZ 18b.Alternate FaaliManifest Reference Number: <br /> ty(or Generator) <br /> U.S.EPA ID Number <br /> V <br /> Faalilys Phone: <br /> Maj 18c.Signatum of Alternate Facility,for(jenerator) <br /> aMonth Day Year <br /> CD <br /> 19.Hazardous Waste Report Management Method Codes(i e.,codes for hazardous waste treatment,disposa6antl recycling systems) <br /> O 1' 2. <br /> -� 19 � i ff ��-I 4. <br /> .j <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1ga <br /> Pnnietl7fyped ame +1 �1 ,,_,� SI re ^j <br /> 1 �� b (,N K� O�� M J 1 Year <br /> EPA Form 8700-22(Ree 12-17) previous edi5ons are obsolete. SIGNA 11W FACILITY TO EPA's e•MANIFEST SYSTEM <br />