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ISI INl Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050 0039 UNIFORM HAZARDOUS 1.Generator ID Number r2Pa—,eI of 3.Emergency Response PhoneManifest Tracking Number WASTE MANIFEST .-AL0003$$I58 8775772669 005888120 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Petco #1319 Petco#1 19 2094787726 5406 Pacific Avenue 5406 Pacific Avenue Generator's Phone: Stockton, CA 95207 Stockton, CA 95207 6.Transporter 1 Company Name U.S.EPA ID Number Gtericycle Specialty W3=_te Solution=_ Inc t+Itd500011k192t 7.Transporter 2 Company Name -5� A U.S.EPA ID Number XIre 8.Designated Facility Name and Site Address 5 Century ry LMWL j. U.S.EPA ID Number 2095 Newlands Lr. Eac_i Fernley, NV 89408 Facility's Phone: 7755752760 NVLr'808953�- 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. , as a eroso s, atstaa e, e yl 1 CF 00003 P 331 D001 D005 o Ethyl Ketone), . 2. 1, ERG#1.2E D007 D035 w a Z 2. LU ,... c.9 I 3. 3 { 4. 14.Special Handling Instructions and Additional Information 6-5 6( erosolti Loosepack) 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above byXe 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 d nationalWgove��patllprr) ulations.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 Co enI certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b) ' 1 am small qu is true. Gen atoe/Offeror's PrintedlTyped Name igna ureBehalf. c o Montay ear �_. 04 301201.r 16.International Shipme ❑Import to U.S. ❑Export from U.S. Port of entry, zit: t— Z Transporter signature for exports only): D to lefivirA U.S.: W 17.Transporter Acknowledgment of Receipt of Materials I All Transporter Printed/Typed Name gnature Month ay Year 01 E a Anthony Mack I I nt4 l .ay Year QTransporter 2 Printedrryped Name , Signature Month Day Year W Z A 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection Full Rejection Manifest Reference Number: 18b,Alternate Facility(or Generator) U.S.EPA ID Number J v LL Facili 's Phone: Month Day Year w 18c.Signature of Alternate Facility(or Generator) ZZ N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1' 2. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Month Day Year PrintedlTyped Name, Signature EPA Form 87-0-0--12(Rev.3- 5) Previous editions are obsolete. DESIGNATED AC LI, T i ESY'J - , STATE(!F DZEG)DlREC'? A70lb-22 12v3 08269796 541004817 041102380 M PD043018 �SD@43018