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f � III VIIIIIII IIII IIIIII IIII 1 Plea200224546CLE 42434158 se print or type. ERI Provider: Clean Earth Form Approved,OMB No,2050-0039 UNIFORM HAZARDOUS 1.Genemlor ID Number 2.Page t of 3.Emergency Response Phone 4.Manifest Tracking Number 'WASTE MANIFEST CAL000392595 1 (877)577-2669 200224546CLE 5.Generators Name and 11I Address Generators Site Address(if different than mailing address) O'Reilly Auto Parts#2765 O'Reilly Auto Parts#2765 430 SOUTH CHEROKEE LANE 430 SOUTH CHEROKEE LANE LODI,CA 95240-4248 Ph:4178747257 Generators Phone: LODI,CA 95240248 Ph:4178747257 a 6.Transporter 1 Company Name U.S.EPA ID Number Clean Earth Specialty Waste Solutions MNS000110924 7.Transporter 2 Company Name U.S.EPA ID Number B:Designated Facility Name and Sile Address U.S.EPA ID Number 21st Century EMN,LLC NVD9808 umber 2095 Newlands Dr.East 6 5338 Fernley,NV 89408 Facilit es Phone: 7755752760 ga, 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11.Total 12.Unit NM and Packing Group(if any)) 13Waste Codes No. Type Quantity WL.N .oI. ,„1 a, 1.UN1950,Waste Aerosols,Flammable 2.1,ERGA IB i o001 - p X 214A. Q 1 CF 00007 P ----._. ....,.___....._ 1 W u 2'UN1993,Waste Flammable liquids,n.o.s.(Acetone,Me mol), 3,PG II,ERG8128 214 D001 X i CF 00004 P 3. I 4. e 14.Special Handling Instructions and Additional Information 1:1006630Aerosols,Flammable) 2.100670(Flammable Liquids) I& 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. marked and Iabeledlplaczrded,aad 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 EPAAcknowledgmem of Consem. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifI am a small quantity generator)is true. 0 Generztors101lerors Prin�drryped Name Si ature Month Day Year \ �5 08 12 12022 ; .I ernationai Shipments F e ❑Import to U.S. ❑Export from U.S. Port of entryandt: ? Transporter signature(for exports only): Date leaving U.S.: § W IT TransporterAcknowfedgment of RemptafMaterials t Transporter l PrintedRyped Name Signature 1 p Month Daq12022 N Trent Pittman �� 08 1Q Transporter 2 Printed!lyped Name Signa Month Da t18.Discrepancy 18 a.Discrepancy Indication Space ❑ puanity ❑ TYPa ❑Residue ❑Pallial Rejection ❑Full Rejection 18b.Alternate Facility(or Generator) Manifest Reference Number: I _J U.S.EPA ID Number C) , aL Faciity's Phone: a ` w 18c.Signature of Alternate Facility(or Generator) Q Month Day Year - Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1 �� 2 3 4. F-� jt2Q. Designated Facility Owner or Operator Certification f receipt of hazardous materials covered by the manifest except as noted in Item 18arrltetllTyped NameSig rture Month Day Yearorm 8700-22(Rev. 2-17) Previous edi6 s are obsolete. DESIGNATED FACII TO EPA's e-MANIFEST SYSTEM .. ,. . . .... IIy _ f