COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

I�IN1 �o11�11� Ptealse pnnt or tXpe.,(Farm designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.N[anHas!Track;nn Number 1 8775772669 008548865 F L E WASTE MANIFEST CAL000383768 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) Dollar General #14353 Dollar General#14313 2'0927513'7 '915°It YOSEMITE AVE 915 E YOSEMITE AVE Generator's Phone: MANTECA, CA 95336-5928 I MANTECA, CA 35336-5328 ransporiar I Company Name US.EPA ID Number Stericycle Specialty Waste Solutions inc I MNSOOO110924 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address u t 1 t iron t a 1 t99—L, Lil U.S.EPA ID Number 11855 White Rock Road Rancho Cordova, CA 95745 Farllily's Phone: 9163510980 I CAD98k884183 9a 9b.U.S.D07 Description(including Proper Shipping Name,Hazard Class,to Number, 10.Containers 11.Total 12.Unit 1 13.Waste Codes HU and Packing Group(if any)) No. Type Quantity Wt./Vol. 1ammable 2. 1, ERG#126 1 CF 00003 P 331 D001 0 Z X 12-UN1993, Waste Flammable liquids, n, o. s. 1 CF 00002 P 331 D001 0 (Alcohol), 3, PG II, ERG#128 3.Non RCRA hazardous waste, solid (Consumer 1 DF 00094 P 331 Products), 4-Non RCRA hazardous waste, liquid (Consumer 1 DF 00136 P 331 Products), 14.Special Handling Instructions and Additional Information 1. 110541(Aerosols) 2. 110518(Flamsable Liquids - Loosepack) 3. 110529(Non-RCRA Solid Waste (CA Only) - Loosepack) 4. 110524(Non-RCRA Liquid Waste (CA Only) - Loosepack) 15. GENERATOR'SIGFFEROKS 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 labeledlplacarded,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 EPAAcknowled rnent of gmwt I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if f am a large quantify ganerekx )(H I a small quan' or' true. Genes yped Name A Month ay rear 1 051 181201- -+ 16.intemafi"l Shipments I-- ❑Import to U.S. ❑Export from U.S. Port of entry/exit:. Z Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrinledlTyped Name Signatufe Monin Uay 'rear n0. Jared Marciel 051 18 201 QTransporter 2 Printed/Typed Name Signature Month ay Year 18 Discrepancy Ise.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Altemate Facility(or Generator) U.S.EPA ID Number J v Facility's Phone: 1 W f 8c.Signature of Alternate Facility(or Generator) Month Day Year Z I i 0 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling s ) G 1. 2. � 3. ` ' / 4. 20. na F 'ty or 0 rator:Certification of receipt of materials covered by to manifest except as noted in It 18a P n N }w / -- I Year � v 1 EPA Formw8700- 2(Rev.3-05) Previous editions are obsolete. SIGNATE CII.ITY TO D NATION STATE(IF QUIR )