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Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 11.Generator ID Number 2.Page 1 of 3.Emergency Response Phone4.Manifest Tracking Number WASTE MANIFEST I 011412829 F L E 5.Generator's Name and Mailing Address enerator's Site Address(if different than mailing address) Dollar General #13568 Dollar General#13568 2098233164 560 NORTH MAIN STREET 560 NORTH MAIN STREET Generatws Phone: MANTECO, CP MONTECe_ — 6.Transporter 1 Company Name U S.EPA I3200 D Number e Cin 7tv to fins rtians Tnr MN lA 7.Transporter 2 Company Name U.S.EPA ID Number r c d 8.Designated Facility Name and Site Address 21st Century EMN, LLC U.S.EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 Facili is Phone:77. 575 P7E, 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11 Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes o X bN1950, Waste Aerosols, flammable 2. 1, ERG#126 1 CF 00008 P 331 DO01 W U X 6N1993, Waste Flammable liquids, n.o. s. 1 CF 00006 P 331 D001 (Alcohol), 3, PG II, ERG#128 XUN3077, Waste Environmentally hazardous i CF 100020 P 181 D009 substances, solid, n. o. s. (Mercury, Broken rn" + I jight Tuhae 1 q Dr, JIT. FRrdki 71 X UN3139, Waste Oxidizing liquid, n. o. s. 1 DF 00042 P 141 D0011 (Hydrogen peroxide), 5. 1, PG II, ERG#140 f 14.Special Handling Instructions and Additional Information 1. 110541 (Aerosols) 2. 110518(Flammable Liquids — Loosepack) 3. 110544(Mercury Containing Waste (Broken Fluorescent Lamp) ) 4, 110525(Oxidizers, Liquid — Loosepack) 15 GENERATORWOFFEROR's CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the 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 and national governmental regulations.If export shipment and 1 am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. / _ on ay Year enera 0—%(-lL� N� \ n 0-- -A-)n CUY'1 ig 16.International Shipments �— ❑Importto U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only) Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printedrryped Name gnature Month Day Year CL Jared Marciel 10 1 20 201 zTransporter 2 Printed/Typed Name G� ig Month ay ear 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 U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Z Z V519 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 3 �4 4oq In 20.Desrgnaled Fadlrty Owner or 6perator:Certification of receipt of hazardous materials covered by the manifest except as rated in Item 18a Printed/Typed al Signature Month Day Yea EPA Form 8700-2Mev. -05) Previous editions are obsolete. ESIGNATED F tr TO DESTINATION STATE(IF REQUIRED) 8700-2212v3 CAL20072032 541053287 041228912 M PD102018 SD102018