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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1•Generator ID Number F2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CARQ�Q�rZ►278325 877571266` 013658225 FLE 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Dollar General #13357 Dollar General#13357 2092531664 1201 WEST MAIN STREET 1201 WEST MAIN STREET Generator's Phone: RIPON, CA 95366-3027 RIPON, CA 95366-3027 6.Transporter 1 Company Name U.S.EPA ID Number Stericycle Specialty Waste Solutions Inc MNS00011LA924 7.Transporter 2 Company Name — --- U.S.EPA ID Number 8.Designated Facility Name and Site Address s U.S.EPA ID Number 2 +95 Newlands Dr. East Fernley, NV 89408 Facility's Phone:77557`2760 NVD980895338 ga. 1 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt./Vol. s` , rite Corrosive Liquid, Basic, 1 CF 00007 P 122 D002 o Inorganic, N.0.S. (Sodium Hydroxide, 9 Potassium Hydroxide), 8, PG II, ERG#154 w X ON1993, Waste Flammable liquids, n. o. s, 1 DM tZ+k1G5c F' X31 ! 01141 CD (Alcohol), 3, PIS II, ERG#128 3. a 4. 14.Special Handling Instructions and Additional Information 1. 1 1 051,.J(Basic Liquids, I n o rgafl 2 c -- L O O s e pack) 2. 110518(Flammable Liquids — Loosepack) 15. GENERATOR'S/OFFEROR'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 labeled/placarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's/Offeror' Print e R d Name � Signa /' �M;onthDay Year 16.Internatio Shipments �� 1 F ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials F- Transporte 1 in 1, Name p Jar'e EtiaY'Clel Signature Month Dai Year CL 08 L 019 Ye Z Transporter 2 Printed Typed Name 1 1 Signa Month Day Year Ile 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Altemate Facility(or Generator) Month Day Year a z w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1 h 2 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year � � k L�>�o q /3 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM 8700-22�12v3 CAL2007LI032 541053271 041514192 M PDO82319 SDO82319