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Form Approved.OM13No <br /> ons-Phone 4.Manlfe rA 8 7 2r9 2 8 J J K <br /> Emergency Resp 8 7 Z <br /> 2.Page 1 of 3• -� <br /> Please print or type. 1.Generator ID Number <br /> UNIFORM HAZARDOUS t;AL000'182804 Generator's Site Address(if different than mailing address <br /> ATE MANIFEST <br /> 5.Generator's ame and Mailing AddressPREMIER FINISHING <br /> 7910 5 LONGEAS y5206 <br /> STOCKTON, U.S.EPA ID Number CAR000272302 <br /> 209-982-5585 <br /> Generator's Phone'. <br /> U.S.EPA ID Number Wg000110924 <br /> 6.Transporter Co AMERICAN AMERICAN VALLEY WASTE OIL.INC <br /> U.S.EPA ID Number <br /> 7,Transporter 2 Company Name CLEAN EARTH NVD980895338 <br /> B.Designated Facility Name and Site Address 21ST CENTURY ENVIRONMENTAL MGIAT OF NEVADA,LLC <br /> 2095 NEW LANL'S DR.EAST <br /> FERNLEY,M( 69408 <br /> 11.Total 12.Unit 13,Waste Codes <br /> 775-5T5-2780 10.Containers Quantity WLNoI. <br /> Facility's Phone: Name,Hazard Class,ID Number, No Type -9m <br /> 9a 9b.U.S.DOT Description(including Proper Shipping <br /> and Packing Group(if any)) <br /> HM F9f"" <br /> --�e1 ,ANIC, <br /> o DM 180 P <br /> DOW 352 <br /> Z A 2. RQ,UN1325,WASTE pLp,MMABLE SOLIDS,ORGANIC,N•O.S.,4.1, <br /> PC311,POLYESTER ABSORBENTS WITH ACETONE G D001 Fqp3 214 <br /> 3, RQ,UN1993,WASTE FLAMMABLE LIQUIDS,NK,05 3,PGII, 7 DNI3<,s <br /> N,o, �- d <br /> ACETONE,PAINT <br /> 4. RQ,1M1283,WASTE PAINT RELATED MATERIAL,3,PGII <br /> 14.Special Handling Instructions and Additional Information <br /> e�_��pyE-y�O.E{Z�.#�64 2.958782-04 ACETEON RAGS ER(.�133 3 <br /> 1_}� .958Tf31-05 PAINT,ACETONE ERG�"12 <br /> 4.PROFILE#1838893-00 THINNER ERGO 128 <br /> EMERGENCY CONTACT:JESSE <br /> n proper condition for transport according to applicable International and national governmen <br /> marked and labeledlplacarded,and are in all respects ti <br /> 15. GENE RATOR'SIOFFEROR'SCERTIFICATION:Thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, <br /> tal regulations.If export shipment and I am the Primary and are classified,packaged, <br /> p p <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. a� at <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or )(if I am a small quantity generator)is true. <br /> Generator s/0" is Pr ntedliyped Name - <br /> ❑Export from U.S. Port of entry/exit: _ <br /> 16.International Shipments Import to U.S. Date leaving U.S.: <br /> Z Transporter signature(for exports only): <br /> W 17.Transporter Acknowledgment of Receipt of Materials Month Day Year <br /> LU <br /> Sig atyre r � E `� <br /> Tran 1 PrintedlT ped Name <br /> CL C1�� S�n Lure Month qDay Year <br /> Z ra sp ger 2 PdntedR e 9 x L <br /> 18.DI repancy <br /> 18a.Discrepancy Indication Space Quantity <br /> ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> U.S EPA ID Num ell'; tA <br /> 18b.Alternate Facility(or Generator) �y - <br /> p permits(s) <br /> P has i,to ro riate <br /> LL Facility's Phone: Pt I on Day Year <br /> 18c.Signature of Alternate Facility(or Generator) tor, a <br /> a this generator is shippi <br /> Z <br /> N19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> I ( <br /> 1 -----_- — 2. Fif 1 -/ ) 3 4. l`1 j) 7' / 'f.� <br /> 20.Designated Facility Owner or Operator:Certificati,n f receipt of hazardous materials/covered by the manifest except as noted in Item 18a <br /> Pri�l\Typed Narne Sign lure Month Day <br /> 33 Year <br /> 1 �? <br /> EPA Form 8700-22(Rev.12 7) Previous editions are obsolete. P SI NATED FACILITY TO GENERATOR <br />