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Please print or type.(Pon designed for use on elite(12-pitch) pewdter.) I�'" "�I'" '"' '"" "I Form Appmed.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator lO Number 2.Page l of 3.Emergency Response Phone 4.Manifest TrackinggNumber E <br /> WASTE MANIFEST 00863174.3 FLE <br /> 5.GenuahleS Name am Matting Address eneraors its Address(if different Ni mailing address) <br /> Oho Rite Rid #6004 Rite Rid#6004 <br /> b` 2092394175 900 North Main Street 900 North Main Street Cardoza C <br /> r GideraWs Phone; MAni-.recA. f'lD MP,ntar _ :F <br /> ( raatponef 1 pany Name .S.EPAID Number <br /> Sf.Pricycle ScRCialty Wa5te Solutionsa A <br /> 7.Transporter 2 Company Name U.S.EPAID Number <br /> G c./� GilGl�ya/Ute/7 <br /> B.DaggMtedFadlityNaMefidSiteAddMU General Environmental Mgt, LLC U.S.EPAIDNumber <br /> 11855 White Rock Road <br /> Rancho Cordova_, CR 95742 <br /> FaatiNs Phone.91 S 019 ❑ o z.> > , <br /> ga 86.U.S.DOT Description(inducyg Pmper Shipping Name,Hazard class,ID Numee, 10.Conlalnen 11.Total 12.VOL Codes <br /> HM aridPadd%Group If MA) No. Type Ovantity _w12. <br /> 13.Waste <br /> jo X 6NI950, Waste Aerosols, [flammable, (each not 1 CF 00004 p 214 D001 <br /> exceeding 1 L capacity)] 2. 1, ERG#126 <br /> z 2. <br /> X UN3266, Waste Corrosive liquid, basic, 1 CF 00002 P 122 D002 <br /> inorganic, n. G. s. (Sodium Hydroxide, <br /> X UN1993, Waste Flammable liquids, n. o. s. 1 CF 00002 P 343 D001 <br /> (Acetone, Alcohol), 3, PG II, ERG#128 <br /> X LIN2811, Waste Toxic solids, organic, n. o. s. 1 CF 100003 F 311 D007 010 <br /> (Chromium, Selenium), 6. 1, PG II, ERG#154 <br /> 14.Special Handling Instructions and Additional lnformallon 101614 11 <br /> 1. 100519(Aerosols) 2. 100564(Basic Liquids, Corrosive) 3. <br /> 97448(Flammable Liquids) 4. 100472(Rx Toxic Solids) <br /> 15. GENERATOR'SIOFFEROR'SCER7lFfCATION: I hereby dedan that On contents of thisconsgnment an fully and accurately descrbed above by the proper shipping Hume,end are darAm,packaged, <br /> marked and Iabeled'placanfed,am amin as msp"In pmpercom illon for aenspon according to epplabie Imemagmal add national goremmental regulations.If export shipmsntand Ism the Primary <br /> Exporter.I certiy tint Ne contents of Ws cauignment contend to the lama of Ne attached EPAAssswwledgment of Consent <br /> I cerlily that the waste minirnizabon sulement identified in 40 CFR 262.27(a)(it I am a large ouantiry generator)or(b)(f I am a smsM Ruenery generate)is We. <br /> nemto errrs t ams ^^ gn Month Day Year <br /> l ` <br /> 16.InlemadonalSNpmenu ❑Imponto U.S. ❑Eeporthcm U.S. Pod of enlryledk <br /> Transmitter signature for exports on : Date leaft U.S.: <br /> w 17.Tansp❑lerAcinowedgmenlot Receipt of Materials <br /> tE Transporter s PdnlmTyped Name Signatur, ` nDay Yeaz <br /> y Jfareod k <br /> a�.dr <br /> z 2 arere <br /> 10 <br /> tI8.Discrep <br /> 19a.Discrepancy Indication Spam ❑ Oumgy ❑TYR ❑Residue ❑paNal RejeWon ❑FUI Rejec4on <br /> Manifest Reference Number: <br /> t8b.NWnu FacAty(or Generator) U.S.EPAIDNumbes <br /> I � <br /> LL Fecili ePhone: <br /> 1Bc.Sig FAJtemate Facility for Generator) Month Day year <br /> 19.Hanimus yyasto Report Management Method Codes(i.e.,codes far hazardous waste treatment,disposal,and mcycrlrg systems) <br /> G 1. 2. 4. / <br /> 2D.Designalk a Iy Dwner or Operator Certification ofneceipt of hazardous materials covered by Ne manifest ex tas notj kg&m 10a <br /> Famewlypeoppis Sgntu Month Dayyear <br /> ha 0 I <br /> EPA Form 8700. (Ref.345) Previous editions are obsolete. ESIGNATED FACILITY T D STINATION STATE(IF REQUIRED) <br />