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11111111M1�111�#1�MMMiMi i lip 0 11111`$ E7t1"2416PSC $35[1$11-©L1 <br /> Pie B}inn} type.(F desigrred(ar 7 U <br /> use on a (f2 pr8ctl) ) '" Form AppeoVed_OMB No.2050-003& <br /> " l3NfFQ6 fiAZAR IIS 1.Generator lDlgumber 2--Page i of 3.Emergency Response Phone 4 tAan€fest Tracking Number <br /> ASTx irtt QST CAL00 01071 (877)577-2669 0020 02416 P S C <br /> 5• r erator's Name and SAailingAddress Generators$i :Address(d different than mail ng address) <br /> BIG GOTS"STORES FOG LOIS 14617:.. <br /> 300 PHtLUP RD,ATrNi:DENA FERARU 1321 WEST"YQSEMM AVENUE <br /> CoLLiNlBIm ON 43228(514)278-4614 MANTECA,CA 95337 20923938$4 <br /> Gener"s Phone: <br /> ratrspQrter i ,pony ame t1.S.EPA ID Number <br /> STERlCYCLE SPECIALTY WASTE SOLUTIONS]NO MNSQ=10924 <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> 8-Designated Fkki Name and Ste Address fI.S,l=Pfi iDHrlrrtber <br /> 21st Century Envirannwntat lil(anagewnt of Nevada LLC NVD986SM38 <br /> 2095 Newlands Dr_East, <br /> Fernley NV 6940.8 (775)375-2760 <br /> FBtifsly's P3tone: <br /> 9a ©b.U.8 DOT Deselipbon(nxduding Proper Shipping Name,Hazard Class,ID Number, to,Containers 11,Total 12.Untt 13. Waste Codes <br /> IjM and Racidng Group(if any)) Na- Type Ouantity %A1 JAL <br /> 1. UT%0WAS-FEAEFMO1_S2.1 331 DWI <br /> X 'I OI±. 4 <br /> Z U 1791 WASTE HYPOCHLORITE SOWTiONS 8 Pr1 i Dom <br /> W <br /> . r3+ x - - - - 1 -DF - 13 P <br /> 3- W2810 WASTE TOXIC,LIQUIDS,ORGAMC,ILOS.(2,4-D)6-1 PGII 331 D©10 <br /> 1 DF 75 P <br /> 4. <br /> 1-0.Spepal liandGng rn5h'oCtiOnS-andlidddionallnfarmalion <br /> (t)Bl OPMOLS-04-ERG(126)M AEROSOLS-04-AEROSOLS(2)W M(;TBLEACW%-ERG(154)BLEACH(3}eLT4%1C-43-ER43(1531 BLTOXIG 03-TOXIC LIQUIDS LOOSEPACK <br /> 15 "GEWJF A'Iaft'$5FFF0t S CERTIE6'n0N: t hereby dedarethat the contents of this oatsonu ent are fully and aeerrrately descn'bed above by ftpropeF sNpOng name,and are SSified,Packaged, <br /> inarked and labetedlpbearded,and are mall respects in proper cortd€tion fnrtranspart accords to applicable fniewional and nafiDnatgovemrmntalregu(aWns.g e>rport shrprnent and l am the Primary <br /> Fxport cIcerWthatthe4mntents•ofthisEPARckmmWledgmenlntCorsefrL <br /> I ce&fy that the waste rttirrhllization Statement idem fred in.40 CFR 26227{a}(if€am a targe quantiygeneraWr)-Jbj(d I 3 SnVK graantity garie;&A is true. <br /> ame" ear <br /> s 16.mffimational5hiprrrerits" 1 <br /> Qtsr�,or<taU.S. .. Fxpvrthorn t#.S: Portotemryiexit. ___�ti_. <br /> . iransportea v7gure Era AsOal Ila}eleav fJ_5.: <br /> W17:TransporterAd=wWgrllonlofReoEptOfM2Wdls <br /> W' �' ru Dn ay Year <br /> 7rdps(7prler- P�nledlFy(red Nan1e <br /> 10 23 18" <br /> Andy Winkler <br /> 7iansparler2Pt�#euiTy*Name <br /> afore _Year <br /> 16,55 repancy <br /> tBa.Diserepwray lndicat4n Space (luaniity <br /> : (r t Fype Residue P,,,-Jd *ctian Full Re*tic n <br /> Rdzrrifest Referenrle Number. <br /> tBb.Afk:maleF.Rly(orCenera(or} - U.S..EPA IDNumber <br /> ftcqaft Phgne. <br /> # F, gnaWre ofAJWe ate Fad ty(or Getivalor) h lont3t t7ay Year <br /> a <br /> 19:tsazardntls Waste Repose Management Ndelfrod Codec(i•e„owes for hazardous waste irearmit,disposal,and reoydir g"systems} <br /> 2- <br /> H0 (1 H141 ¢ <br /> Hl-41 <br /> 20.Uesign�ed Facility flwrter or gperator.r ertfiealilan of ipt of hazartlousrriaterUs (tem 186 <br /> Signah9e <br /> EPA Ft}trrt 878th 2(R&3 F}5) (evious editibns'am obsolete. <br /> s, , •a �: a <br />