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Please print or type (Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.205D-0D39 <br /> UNIFORM HAZARDOUS 1 Generator ID Notes 2,Page 1 of 3.Emetger cy Response Phone 4,ManlfestTra,:WngNt9kb t <br /> WASTE MANIFEST CAR00Qt278325 877577a669 012120100 FLE <br /> 5 Generators Narne and Mailing Address Genermors SdeAddress(if ditf"nt than mafllrrg <br /> Dollar General #13357 Dollar General#13357 <br /> 2092531664 1201 WEST MAIN STREET 1201 WEST MAIN STREET <br /> Generatat'sPhone. RIPON, CA 95366-3027 I RIPON, CA 95366-30227 <br /> 6, ranKio. r t Company Name U:S.EPA=D IJumber <br /> Steric cle Specialty Waste Solutions Inc MN50001109;;4 <br /> 7,Transioniter 2 CoawpnyName U,S,EFA ID Nv"er <br /> Worldwide Recovery Systems CAROIZO175422 <br /> 8.Designated Facility Narnea9dStteAddressYulata Yes, LLQ <br /> U.S.EPA IDNumoer <br /> 2730 E. 13th Street' <br /> Yuma, AX 85365 A <br /> Facif' 'sPhme:9286428938 <br /> Sa. W t1-5 DOT OesxiOon VwkW g Proper Shipping No".Hazard Class,ID?Amter, 1O.Gontakier4 It:Total I2.Unit 13.Waste Codes <br /> HM amid Hack ng Gnu a{danyj} No. Type Quantity Wt Not, <br /> 'Non RCRA hazardous waste, liquid (Consumer 1 DF 00112 P 331 <br /> Products), ; <br /> Non RCRA hazardous waste, solid (Consumer i DF 00230 P 331 <br /> LU <br /> Products), <br /> s; <br /> a. <br /> t 14,spec.4ha,dingtnslruclierrs and Addaona'"forr"earn 1. 110524(Non—RCRA Liquid Waste (CA Only) — L:oosepack) 2. <br /> 110529(Non—RCRA Solid Waste (CA Only) — L.00sepacky <br /> Ia. I TW'5*FFl7t0R%c6R'nMATIM t hereby deft*ate Tse omlarrm d t&oonei FMV are hft ertd desaDed.OM byte proper st**v haute.wtd He cw wted,packaged, <br /> merioed ane�,end are ht g resp"in prr M oorx7om lor tgsmom aooir*g to Vohgft MbmatlorW rand fob"W%vr menW saguabons.It expod shornam end t am ON Pflmery <br /> l,g arser,I ce y go ft wnraree arfteonalgnmenl owftm to vte sepos vt ate mmdted EPAAdvWMP#NrKdCa wi. <br /> Mont i' aret lire wide�sl>+nnrbnt ident�Ged lin sa CFR z�zr(q(a l an a�m>� or Gu�H get�raEor?�a>». <br /> Day Year <br /> x <br /> I1$ 02 tai <br /> 18:httemaMW Sh pments Eli tl,S. ❑F.lf W from U3S Pott d <br /> .Transportersionahxe(fr etfoorts oi*11 VA levirm U- : <br /> 17.Transporter Ackamsfedgmeel of Receipt of Af*i s a b=f <br /> ransporfer 1 Prtraedrryped Name Month Day <br /> a Jeff Hamilton I lei 02122011 <br /> ypad'Name MOM ay Year <br /> 1 Vol I rV I <br /> tD.Drsrx>wpancy f' _ <br /> tea.Discrepancy Ind.486al Space Qwr>aty aType ❑Residue ❑Partial Refection l t Fo:l Rejadon <br /> f <br /> MaatestReferertcehumber: ' <br /> 18b.Attemato Facility(or Generator) U.S.EPA ID Nun her <br /> r <br /> V 1 r`tz Facddy'sPhone! <br /> 180%nature of Artemate Fablity(or Generatorl Month Day Year <br /> LU <br /> 1 � 1 <br /> 19.Hazarwrs Vit*Repoli,Mahagernera Method Codes(I.E.,codes for huardous waste treatment,disposal,and recytsing systems) <br /> 1. 2. 3. 4.. <br /> 1ti 1 ► 1 <br /> 20,Designated Fadatq Owner or Operator:Ceniftoationof receipt of hazardous materials covered by the fear ifest exr s noted in Mm laa <br /> PriPtedlTy,R a y M" D8y Year <br /> I Au v4Nk IQ 2 ( 1 1011UI � <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGgED Fk TY TO DESTINATION STATE(IF REQUIRED) <br />