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Reviewing the Hazardous Waste Manifest <br /> The manifest tracks hazardous waste from the point of generation (your store) to the point of <br /> its ultimate disposal. It's part of the "cradle to grave" process. As the waste generator, we are <br /> responsible for ensuring that the manifest is accurate. Be sure to: <br /> Please print or"(Foch designed for use on elite(12-pilch)Iyp nler) Form Approved.1M1112050139 <br /> UNIFORM HAZARDOUS 1.Generator IC Number ge 1 0 3.Emergency Response Phone e.Manifest Trp i,Number <br /> WASTE MANIFEST CRL000409i 775772669 012074856 FILE <br /> 5.Generators N._and Maiimg Address Gcnrralors GaeAGdress IR dlflemnl Man mailing atldress) <br /> Verify that the EPA ID, Dollar Tree 06189 Dollar Treeit06189 <br /> (000) 000-0000 342 S. Indian H111 Blvd 342 S. Indian HIll Blvd <br /> store number, and Generamrs phone; Cl aremant, CR 91711 Claremont, CA 91711 <br /> 6. ranspwlerl moony Name U.S.EPA ID <br /> address are correct. Ster icycle SNumher <br /> pecialty Waste Solutions Inc -M-M00i 10924 <br /> 1,1rer1512 Con%Siny Name 11.5.EPA In 1— <br /> L11 <br /> — <br /> r U.s.EPA ID Number <br /> 2095 Newlands Dr'. East <br /> Fernieya NV 69408 <br /> Fsl s,_7755752760 VD980i <br /> 9. 9b.U.S.OUT XSOPWM od!Wing PW Shipprg Name,HOTad Class,ID Number 10.Cii,,Mnacs I1-7epa1 12.Unnh <br /> HM andr'ack'mg GroupolanyllTypeOmntily 13.Wast¢Codes <br /> d5 a ammo a 1QUi 5, B.D.5. <br /> o fRcetone. MethvI Ethvl Ketone). PG II. <br /> RGi1128 <br /> Review the type/weight z Waste Rerosals, tiammarme 2 <br /> of waste picked up. -------jo. " <br /> Weight is typically <br /> noted in pounds (P). 4. <br /> 14.special Halling lnstrucgmsand Additimal lnfonnalbn lq U1 s — ero=0 5 <br /> Verify the date is GElifl 1TON'SOFFEN01TSCERTFICATION I eeby dedae Naltln cm eM6d M1gN 9gnmenlare hAlyaMa% aOCh dE9Mbetl ahO eby Meppper shippi g name.antlare Ga shied,pa ageQ <br /> narked n.re <br /> end IabelApr—rded,and am in aNl els In i—nae.V",i aLcording loapp <br /> tieabl0 mtemalituW ell rmlMal goVammentaneguia!'rans.II export shignent all 1 am Mle primary <br /> correct. Legibly print, Epp�r Icend eat��en�dlh,swnpgn ent�{�mtotM1e�m,p„�a�edEPAA�nppad��daDwaanl <br /> wd'Ity Ural Ida waste mirymlzat'Iwa ear ldennged in qq CFR 262,71[a)[Vl lama targe Ouangty gerrereaa)gr(M1)tltlama all quartory genaramr7 as hue. � <br /> and then sign your6eRd�sO °nPnNa t a q a ear <br /> 06 Epla <br /> name. if 16.I"Is— Ship ©knpmt to US ❑ihon I1 S. "f enlrylelt: <br /> _ - - - <br /> — Lan otter si nature I or aqnl . Dam lean U. <br /> w 17.TariA—iiegmenl of RANO ofWaMim, <br /> mnspaterl yped Name gnB 2 n ay ser <br /> a Salvador Guzman 0i <br /> 120f 18 <br /> 2 Transpoder2PnnledlTyped Name a Mpn[M1 y Year <br /> t9.o�apaney <br /> 16p-PiaGepanty Indjeadpn$pane ❑Ouanlit, ❑T" ❑Residue ❑Eodw ri{atlipn C.h',II Rej-1— <br /> Manilas[Relerence Number <br /> 1 Bb.AWrnsle Faaithy[q'Gmanlor) U.S.EPA ID Number <br /> V <br /> la4- Feer sPhene. <br /> 18c.5gnaMe pfAllemele Fddhy(Or C�nCeM1Y] Month oay Year <br /> i <br /> h <br /> 19-Hesarrbus Waste RepM Meragerrrall Moi Curios tie,.mtles br Naxardnus waste­rt dspgsel.ab recycling syst¢msl <br /> 21.De_sigoalad fad it,Owner or ope—C"b ion Of re¢eiP1 Of hwoN &matenals—od by to mani—pt os n°tedin Item l Aa <br /> Print¢dl e , Sign Mon nZ N1 Oa Y <br /> EPA Form 8700-22(Rev.3-05)Previousedld°ns are obsolete, L DESIGNATED FACILITY TO DESTINATION STAT[ tIF REQUIRED) <br /> Within 30 days of the pick-up, you should receive a final manifest in the US mail. Signatures at the bottom <br /> (like those above) verify that the waste was received at the disposal facility. Staple this final manifest to <br /> the initial manifest and place them in the "Manifests" folder or binder. Retain both manifests at store <br /> level for 5 years. If a final manifest is not received within 30 days, notify hazardouswaste@dollartree.com. <br /> Important: Our vendor provides copies of the manifest to DTSC (a CA state agency) <br /> on behalf of Family Dollar and Dollar Tree. <br /> Hazardous Waste Quick Reference Guide 9 May 2019 <br />