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PieasB pi9ltt or b". I Gene 111111111111111 Form Approved.ONIS No,2050-0039 <br /> UNIFORM HAZARDOUS MIX 10 Number 2.Pais I of I Emergency Response Phone <br /> WASTE MANIFEST CAL800374240 11 18775772669 1 n1 An <br /> 5.C*neraWs Name and Mating Address Generators Site—(�merent than 10726 FLE <br /> Address UN=7' <br /> Dollar General #13585 Dollar Beneral#13585 <br /> 12096849866 2150 W ALPINE AVE 2150 W ALPINE AVE <br /> Generators Phone: RT17111714TON, CA 95204-2853 STOCKTON. CA <br /> 0.transporter I Uompany Name U.S.EPA ID Number 95204-2853 <br /> StericYCIO SP9Cialty Waste Solutions Inc <br /> 7.Transporter 2 Company Name IMNS000110924 <br /> US.EPA II)Number <br /> Wo rldwide Recovery Systems If- R000175422 <br /> 8.Designated Fnly Name <br /> and <br /> Site <br /> Address Yu ma Yes, LLC U.S.EPA ID Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Faolil f's Phom,926642A238 -- <br /> 1AM008515924 <br /> ga, I 9b.U.S,DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10 Conte <br /> HM and P"Group(V any)) 11.Total 12.Unit <br /> No. Type Quaintly Wuvol- 11 Waste Codes <br /> l. Non RCRA hazardous waste, liquid (Consumer a DF 00167 P 331 <br /> Products), <br /> Z 2. <br /> Uj <br /> 0 <br /> 3. <br /> 4. <br /> 1 1-10524—( — <br /> Non i <br /> 14.§;;;0 Handling IngtruMor,and AmAdlMhow-Wal RcRA Lit, <br /> Ir <br /> on— RA Liquid Waste (CA Only) Loosepore k) <br /> I& GENERATOWSIOFFEROIrSCEFMFICATIOW-thereby declare that the contents Of this consignment are fully and accurately bed above by Me POW shipping name,and am classified,Packaged, <br /> malked and tabelediplaconled,and are in all respect m proper oor4lbch jor transport according to applicable,witemat"wand national g0mmiental regulations,d export shipment and I am the Primary <br /> Exporter,I 0W*that the 0DRIents of this consignment conform to the terms;of the attached EPA Adnowiedgment of�"t <br /> I certify that the W8fiW42&idZabW statement kilindifled in 40 CFR 262-27(a)(d I am a large quantity generator)or Of(If f am small quantity ge~fj—s <br /> s Prat <br /> Year <br /> `I-� ❑Import to U.S. ❑Exlprt from U.S. Pat of enbytexik <br /> Transporter (fw expoAe why}: <br /> Dab lea clog U.S.: <br /> W <br /> LU <br /> Transporter <br /> 0 Month Day Year <br /> U) 2 yped <br /> JIA7 lip lip 410m <br /> CU JV&6 Day Year <br /> 18.Dwepancy V)/ Joy L16 <br /> 18&1 Dwepancy Indication Space ❑ <br /> Quantity ❑Tyr. ❑Residue ❑Partial R.O. <br /> I % El Full Rejection <br /> l6b,Alternate. Manifest Reference Number <br /> U.S.EPA 10 Number <br /> LL Facility Phone: <br /> 18c.Signature ui kywriaw 0-aci6ly(or uenerator) <br /> M" Day Year <br /> CO) 19.Hazardous Waste Report M"ement Method Codes 0 J <br /> tyl1- -8-OD60S for hazardous weeds treatment disposal.end recycling systerne) <br /> 2, 4. <br /> 20.Designated Faddy Owner or 3p;;t—,:Certification of receipt of hazardous me"00 Bred by the manifest except as noted in!bin A8a <br /> n Name <br /> 1J 1 � lr Signature v —Ww—My Year <br /> M <br /> EPA F 8700-22(R re obsolete. 01 luv <br /> DESIGNATE ACIL11TY TO EPA'S e-MANIFEST SYSTEM <br />