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Please print or type, Form Approved OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I-G—ravIDNumbor 2.Page lof 3,ErnergencylResponsephone Manifest Tracking Number <br /> WASTE MANIFEST HAZARDOUS i_ <br /> 8775772669 <br /> 5.Generaloes Name fing Address ];=r 1-013652474 FLE <br /> Generator's Site Address(d different than ma"ng�V",(,ss) <br /> Dollar General #14353 Dollar Genpral#147�"3 <br /> 2092751377 915 E YOSEMITE AVE 915 E YOSEMITE AVE <br /> 0eTm-*raPhone: MANTECA- 170 q 336-5928 <br /> I Compo I MANTECA, CA 95336-59a6 <br /> Transponne, ny N <br /> "'0"e " ny <br /> "ny <br /> U.S.EPA to Number <br /> teric cl ecialt Wa lutions Inc IMNS <br /> r rter 2 ompitay Na 0-01 0924 <br /> V. N <br /> qrnateedF ityNammaand& dress yUMa Yes, L PAID mb r <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Faccil" 's Phor*'1928 <br /> SAPPing Name,Hazard Class.to Number, 10.Containers <br /> 9a. Ob.U&DOT Description(including PrOWAZROQQ5152 <br /> HM and Packing Group(if any)) 11.Total 12Umt 13.Waste Codes <br /> No, Type Quantity AjNoj, <br /> �on RCRA hazardous waste, liquid (Consumer DF —— 331 <br /> 0 00127 P <br /> P <br /> t- <br /> roducts), <br /> 2. <br /> Uj <br /> 3. <br /> 4. <br /> 14,Spedai Handling Insbudws and Additional infoin-at'W-T.-T,0..524(Non-RCRO Liquid <br /> CA Only) Loosepack) <br /> 15 GENERATORVOFFEROR'S CERTIFICATION:I hereby declare that ft ccr,,tents of h$OD are f ty d a -- -rd <br /> 7pp=" and I S",' the Primary <br /> marked and liabe"olacarded,and am In ail resp"in propet condition for transport acuDrdi rtsignmitnt ORY and accurailli describe above by the proper shipping name,arta .classified,pajkaq <br /> ng 10 OPPIk"international and nabonat govt�mmanVtaj regulations,If expert ship <br /> ExPDf*,I cer*that the cwtentS of this consil;lninent conform to the tens of the attached EFAAcknowledIgmint of Cw*nt <br /> 1 Coley that the waste minknilatiOn statement identified in 40 CFR 26227(a)(If I am a large quantity generator)or(b) a strati quantity generator}is <br /> Genet a Nitted/Typed N <br /> month Day year <br /> F]kPA to u,,q <br /> 11E from U.S. on of entrylext <br /> Z Trainsporteir sig re(for exports Qtly); Date leaving U.S: ............................................................... <br /> IX 17,TtanspxterAcknowledgmetj of Re"Of Maktri* <br /> LU <br /> prin <br /> Sena Month Day Year <br /> K ' t her Imanza <br /> Tr 30 L019 <br /> :dlbl Narita <br /> G <br /> 16 ZInLrStd <br /> Month Day Year <br /> 18a.Dmore Indication$Pace <br /> "ca", I-pace QuanfityYype Psido. <br /> Partial Rejection D <br /> El Full Rejection <br /> Ca <br /> ut Facility's Phone! <br /> l8c.Signature Of <br /> rdernale t-amty lot Ueneratort <br /> Month Day Year <br /> Z <br /> 0 <br /> 19�Hazardous Waste Report lk`13nageMot MedW Codes(i.e.,codes for haZ111101,ls waste Iment, ,disposaland to, <br /> UAUA . Trecycling systems) <br /> 1 <br /> 3. <br /> 4. <br /> 20.Designated Facility Owner or Operator Certification of receipi of hazardous—materials covered by the manifestaxotip,as noted m Item 18a <br /> Pritiliedrryped Naftie <br /> Signature <br /> 6 MLA.U t knill Day Year <br /> .......... 0— A-1 ", <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete.. 11 <br /> ESL N j E ACILITY TO EPA's 9-MANIFEST SYSTEM <br />