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Please print or type.(Form-designed 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 Traoldnry Numbe <br /> WASTE MANIFEST I CAL00 X383.768 i 1817 5:72E5 9 010168248 F L E <br /> 5.Generators Name and Mailing Address Generatogs!kAgAddress(d different than mailing address) <br /> Do!lar General #14353 Do!!at- <br /> G riet l#71=5= <br /> c"2092751317 915 E YOSEMITE AVE 915 E YOSEMITE At"E <br /> GeneratorsPhorre:2. • MANTECA CA 95336-5920 I MANTECA. CA 953_E7-5926 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericvcle speci-alty Waste Solution_ in[ I iii'!SA'u'r>r11f�+� a <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> I <br /> 8.Designated Facility Name and Site Address General En v i r'o n w e n t rt i Mgt, LLC U.S.EPA ID Number <br /> 11855 White Rock Road <br /> Rancho 'Cordo-.a, CA 95742 <br /> Facilil ies Phone:9163.51(h913Lr CA8984384163 <br /> ga. 9b.U.S.DOT Description(inducing Proper Shipping Name,Hazard Class,to Number, 10.Containers 11.Tatai 12.Unit 13.Waste Codes <br /> HM and Parting Group('d any)) No. Type Quantity Wtivol. <br /> X 1UN1950, Waste Aerosols, flammable 2. 1, ERG#126 1 CF 00004 P 331 DO01 <br /> 0 <br /> LU <br /> 44on RCRA hazardous waste, solid (C.Dn_umar- 1 GF 00W P 3--1 <br /> r, Products), <br /> Stan RCRA hazardous ;waste, liquid (Consumer i DF 00093 P 3.31 <br /> Pr=orr-Ict s). <br /> 4. <br /> 14.Special Handing Instructions and Additional Information 1. 110541(Aeroao1s) 2. 110529(Non-RCRA Solid Waste (CA Only-l' - <br /> Locsepack) 3. 1.10524(Norn-RCRA Liquid Wa=te (CA Only) -- LaDSepack:) <br /> 15. GI FIERATOR'SfOFFE ROR'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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terns of the attadtad EPAAckrwwledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(d I am a small quantity generator)is true. <br /> 7toest <br /> d/ryQeroes-Frinteped Name Month Day Year <br /> I C r I 13 I21-711 <br /> J 1�. <br /> Inliernetional Shipments <br /> t= ❑Import toU.S. ❑Export fro�U.S. Pod oJentry/exit: <br /> Z Transporter signature(for exports only): n Date leaving U.S.: <br /> W 17.TransporterAddwv4edgment of Rece pt of Materials <br /> / t _ AAl // /7 � <br /> W Transporter 1 Printedlfyped Name i Month Day Year C <br /> a Anthony Mack I 071 131 +1 <br /> W <br /> Transporter 2 Printedffyped Name Signature Month Day Year <br /> I I <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Residue ❑Partial R'dian <br /> tdy ❑Type efe ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> LL Farf s Phone: <br /> w 18c.Signature ofAltemate Fadity(or Generator) Month Day Year <br /> Z I I I <br /> 0 19.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,� posal,and recycling systems) <br /> ILI <br /> In 1 � I� I3 ��1 I4 <br /> 20.Designated Facility Owner or Operator.Certification of me*of Itazatdprq materials covepd by the manifest exW ah noted int 8a <br /> .1-111 <br /> T a Signature r <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DE NATED ILITY 7 Q ATIt3N 5T E(IFR QUIRED) <br /> t3=11!P7I 2_12x3 CAL20072032541053328 040688311 M P➢07131 58071317 <br /> i <br />