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PI n IN 111111111111 Form Approved.OMB No.2050-0039 Please pn t or type.(Form designed for use on elite(12-pitch)typewriter pp UNIFORM HAZARDOUS 1.Generator ID Number 2 Page i of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000374267 11 18775772669 _ 1 010790158 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) . Dollar General #13568 Dollar General#13568 2098233164 560 NORTH MAIN STREET 560 NORTH (MAIN STREET Generator's Phone: MANTECA CA 95336-3900 MANTECA. CA 95336-3900 6 Transporter 1 Company Name US EPA ID Number Steric cle Specialty Waste Solutions Inc IMNS000110924 7.Transporter 2 Com any Name U.S.EPA ID Number LS � z �► ✓ 13zi3� 8.Designated Facility Name Orr Site Address benera 1 Environmental , LLC U.S.EPA ID Number 11855 White Rock Road Rancho Cordova, CA 95742 Facility's Phone:916351$980 CAD980884183 9a, 91b 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. Non RCRA hazardous waste, liquid (Consumer 1 DF 00073 P 3311 a Products), z 2. w 3 e 4 14.Special Handling Instructions and Additional Information 1. 110524(Non—RCRA Liquid Waste (CA Only) — Loosepaek) 15, GENERATOR'SIOFFEROR'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 I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment 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, Ge m Mom ay ear j 16.Intemational Shipments H ❑Import to 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 Printed/Typed Name 6ignature Month Day Year a 1 I I I01 L017 z Transporter 2 Printed/Typed Name Signature Month Day Year I � I1-7 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial RejectionEl j Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) Number I Facility's Phfn4qV1 9,7)-K 'M: I A L oV 3 3�3 w 18c_Si AIS (or Generator) f Month Day Year !R -+ Z' I � I1 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste trea sal,and recycling systems) LU 01 1(/ / q/ I2 11 4. 20 Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature Month Day Year 41/n ( ��t-�C I I I EPA Form 8700-22(R u.3-05) PFevious edifions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)