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Please print ort e. designed I� <br />YP (Form gned for use on elite (12 -pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br />UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number <br />WASTE MANIFEST AL'0ti,0425 71 y 1 E f? t +_66 0 05888088 F L E <br />7- _. <br />5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) <br />Petco - 1291. <br />c09�350 W 1.'63�-6107 2350 W. KETTLEMAN LANE SUITE 120 2 W. <br />91 <br />Generator's Phone: Lodi. CA 9524E 2x50 KETTLEMRN LAME SUITE 1 0 <br />6. Transporter 1 Company Name Lodi. CA 95242 <br />U.S. EPA ID Number <br />Ster-icycle specialty WiEte 3t lotion_ 1€ac <br />7. Transporter 2 Company Name <br />U.S. EPA ID Number <br />8. Designated Facility Name and Site Address 21 5t Century EMM, LLC U.S. EPA ID Number <br />2095 Newlartds i East <br />_ Fernley, NV 89408 <br />Facility's Phone: 1755752 760 <br />ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers <br />HM and Packing Group (if any)) <br />No. Type <br />Y <br />'UN1350, Waste Het^osois. Flamm ble, (Methyl 1 F <br />EthvI Keterie C.1. ERCC-H <br />Z 2. <br />LU <br />0 <br />3. <br />4. <br />_ I 3566(Aer�osols Loosepacw) <br />tile, D9608953 8 <br />11. Total 12. Unit 13. Waste Codes <br />Quantity Wt.Nol. <br />' A l l P 331 D001 1 DO05 <br />D00 I�uw <br />}0,3 s <br />15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper sInping name, and are classified, packaged, <br />marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmenta/Ztrue ti s. If export shipment and I am the Primary <br />ey� <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Cons) <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifAm a sn)all quantity ., - <br />=J 16. International Shipments <br />❑ Import to U.S. ❑Export from U.S. <br />Z Transporter signature for exports only): <br />Li 17. Transporter Acknowledgment of Receipt of Materials <br />Transporter Printed/Typed Name i atu <br />a Anthony stack <br />QTransporter 2 Printed(ryped Name Signatu <br />baa I <br />Port of entry/exit: <br />18. Discrepancy <br />18a. Discrepancy Indication Space <br />❑ Quantity ❑Type ❑Residue <br />18b. Alternate Facility (or Generator) Manifest Rete <br />J <br />U <br />Q <br />Facility's Phone: <br />Lu 18c. Signature of Alternate Facility (or Generator) <br />a <br />z <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systei <br />D 1. _M 1 2. 3. <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as ted ii <br />Printed/Typed Name � Signator <br />M 0y) I krun A 16-, <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. <br />11 1 S710-0-22 12v3_C8269796__ 541070920 041090700 M <br />Item 18a <br />❑ Partial Rejection <br />EPA ID Number <br />4. <br />I D FACILITY 75' <br />PD041818 <br />041 181201 <br />04 18 1201? <br />onth Day Year <br />V I Z fV <br />❑ Full Rejection <br />ON STATE (IF REQUIRED) <br />SD041818 <br />