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-- � �IIIII�IUNIIiN11N�1111IllIIIII �--.-- 280598-18 _ 001947264PSC ' 3266885-001 Please print or type.(Foran designed for use on elite(12-pitch)typewriter.) i,� /7 t,'q I Form Approved.0M8 No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Paget of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000391069 2 (877)577-2669 001947264 PSC 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) BIG LOTS STORES BIG LOTS#4105 300 PHILLIP RD,ATTN:DENA FERARU 8001 WEST LANE COLUMBUS,OH 43228(614)278-4614 STOCKTON,CA 9521.0 2094732823 Generator's Phone: s 6.Transporter I Coin-Fany Name U.S.EPA ID Number STERICYCLE SPECIALTY WASTE SOLUTIONS INC MNS000110924 - 7.Transporter Company j� U.S.EPA ID Number g (Yck di C, 8.Designated Facility Name and Site Address U.S.EPA ID Number 21st Century Environmental Management of Nevada LLC NVD980895338 2095 Newlands Dr.East, Fernley NV 89408_(775)575-2760 Facility's Phone: 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13. Waste Codes No. Type Quantity WLNoI. 1. UN1950 WASTE AEROSOLS 2:1 331 D00t O 0 X 1 DF 5 P Z2. 00 UN1993 WASTE FLAMMABLE LIQUIDS,N.O.S.(KEROSENE,DIESEL_)3 PGII. 331 D1 0005 X 1 DF 13 P t. D007 D018 D035 3. UN2810 WASTE TOXIC,LIQUIDS,ORGANIC,N.O.S.(2,4-0)6.1 PGII 1 331 D016 r - X 1 DF 51 P _ y .. 4. UN3266 WASTE CORROSIVE LIQUID,BASIC,INORGANIC,N.O.S.(SODIUM HYDROXIDE, POTASSIUM HYDROXIDE)8 PGII 141 #' D002 14.Special Handling Instructions and Additional Information (1)SLAEROSOLS-04-ERG(126)BLAEROSOLS-04-AEROSOLS(2)BLFLAMLIO-W-ERG(128)FLAMMABLE LIQUIDS(3)BLTOXIC-03-ERG(153)BLTOXIC-03-TOXIC LIQUIDS LOOSEPACK (4)BLCORRSASIC-04-ERG(154)BLCORR13ASIC-04-BASIC CORROSIVE LIQUIDS 15. GENERATOR'S/OFFEROR'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 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 codignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(3)(if I am a targe quantity generator)or(b)(if I am a small quantity generator)is true. - nerator's/ a not hyped arae 6ignature Month Uay Year 8 1, 20 18 -a 16.International Shipments. Z ❑ El to U.S. Export from U.S. Pod f of entry/exit: -- Transporter signature for ex its onl Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials LU OTransporter 1 Printed yped Name Signature on ay Year a Andy Winkler ( 8 120 i 18 QTransparler 2 Printedfl yped Name ignature Month Day Year 9Z -f lit 18.Discrepancy 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: . 18b:Alternate Facility(or Generator) U.S.EPA-ID Number W Facititys Phone: w 18c.Signature of Altemate Facility(or Generator) Month Day Year Q _ Z _ 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Lu 1 12. 3. 4: I+ k H141 H141 H141 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noW in Item 183 Printedfryped Name,.._- Signature M EPA Form 8700-22(Rev:3-05) Previous editions are obsolete.