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3881930 <br /> 0 0?3 01—2 0 f=orm Approved.OMB No.2050-0039 <br /> Please print or type, 2.Page 1 of 3.Emergency Response Phone 4,Manifest Vackin Number <br /> UNIFORM HAZARDOUS t•Generator ID Number oO O 3 7025 DAT <br /> WASTE MANIFEST CAL00O449995 1 (B7-, <br /> ing address) <br /> 5,Goner lot's Name and Itilai ing Address <br /> Generators Sile Address(if d!([erenl Than mail <br /> Ste»ilt World F3001ls Fruit <br /> Cilinchnilp 5teeilt <br /> 7732 Fnpp <br /> 7732 Fnppiano Lane C9 <br /> A Lane <br /> Generalor'sPhone: Stockton CA 95715 5toCktQri95215 <br /> U.S.EPA ID Number <br /> 8.Transporter t Company Name MNS00011.0924 <br /> STERICYGLE SPECIALTY WASTE SOLUTIONS INC U.S.EPA lDNumber <br /> 7,Transporter 2 Company Name <br /> U.S.EPA 10 Number <br /> 8.Designated Facility Name and Sita Address <br /> 0 ROM CUR}BV4 LLC DIA PSC EEVIRON11 4ITAL SERYLS <br /> 11855 White Rack Road CAD98O884183 <br /> Facllity's Phone: RAM CORD(3V13, CR 1574.2 (911) 351-11" [�i 1z <br /> Total . <br /> sg.Containers 1t. unit <br /> 9a, 9b,U.S,DOT Description(including Proper Shipping Name,Hazard Class,!D Number, 13,Waste Codes <br /> No. Type Quantity WLIVol. <br /> HM and Packing Group Cif any)) I�1 <br /> 1• MR-'RUHR KRI KD4lt5 Milt, SRLIi3 (ENTY TOTE LAST GONTAIHIRfi P <br /> o I}I1�R.IN RA-75) TP <br /> 2 <br /> [u <br /> 3. <br /> 14. <br /> 14,Special Handling Instructions and AddiGoaal Information <br /> 113 163fi479-84 - EMPTY TOTE <br /> 15, OENfRATOR'SlOFF£ROR'S CERTIFICATION:1 hereby declare that the contents 0 this consignment are fuity and accurately described above by the proper sAipping name,ani ace classified,packaged, <br /> marled and iabeledlpEROR'S and are in all respects in proper condition for transport according to applicable inlemationaland national governmental regufalions.If export shipment <br /> and I am the Pr maty <br /> Exporter,I certily[hal the canleats of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify[hal tha waste minimization statement Identified in 40 CFR 282.27(8)(it I am a targe quantity generator)or(b)if I am a small quantity generator)is fru . Month Day Year <br /> Signature <br /> Goner lersl0fferars Print MIypad Name <br /> 6,nter 'onal Shipments import la U.S. ❑Expert from .S. Port of en"lexit: <br /> Date leaving U.S.: <br /> Transporter signature(for exports only): <br /> rL' 17Z;;Z <br /> Trans ponerAcknowledgmenlotRecelplofMaterials Stgnsur Month Day Year <br /> � ped a a Q <br /> rJ� Month Day Year <br /> a Slgn t e <br /> ntedlfyped Name <br /> 18.Discrepancy <br /> 188,Discrepancy Indication Space L1 Quantity ❑Type <br /> El Residue DOW Rejection Full Rejection <br /> Manifest Reference Number: <br /> U.S.EPA ID Number <br /> 18b.AltorDate Facility(or Generator) <br /> Z3 <br /> U <br /> u Faelld/s Phone: Month Day Year <br /> 18e.Sfgnalura of Alternate Far lily(or Generator) <br /> LU4 <br /> Z <br /> 0 1g.Hazardous Waste Report htanagsmeni Method Codas(Lo.,codes for hazardous waste treatment.disp3sat,and recycling systems 4 <br /> � t 2. <br /> C ' <br /> 20,Designated Facility Owner or Operator:CertifcalJon of receipt of hazardous materials covered by the manifest except as acted in Item t 8a Month Day Year <br /> Signalura C <br /> Prinledffyped area ^'�' <br /> EPA Form 8700.22(Rev.12.17} Previous editions ase obsole e. <br /> ESIGNAT FACILITY TO EPA's 0-MANIFEST SYSTEM <br />