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668822-17 <br /> Please print or type-(FOM(FOMdesigned for use on elite(12-pitch)typewriter.) 001&552$3ASC L"K&- i�t IF;/,) 290395-001 <br /> Form A <br /> t Generator Irl Number 2.s t f Emergency Response Ph— d.Manifest rrnking Numbcr <br /> prtwed.OMB Na.2[150 0039 <br /> UNfFORM HA7_ART)QUS age o 3 <br /> MANIFESTWASTE caL000391069 2 (877}X77-2fi69 Q0�65283 PSC <br /> 5,GCnr;ralOr's Hance aid h4ailing Address Generator's Si(eAddress(d diflervnt lAan Mailing address( <br /> BIG LOTS STORES BIG LOTS#4105 <br /> 300 PHI LOP RD,ATTN:DF NA FEFTARU 0001 WEST LANE <br /> COLUMBUS,OH 43226(614)278-4614 STOCKTON,CA 95210 2084732823 <br /> Generatc(,s I-hone <br /> 6.Trarr3porler 1 Company mama US FPA 16Flrmnber <br /> STERiCYCLE SPECIALTY WASTE SOLUTIONS INC MNSODW10924 <br /> 7.Transporter Z Company Name _J. U S EPAI# NNang <br /> .fyry(Ya � <br /> 8.Designated Facility Name and Silo Address U.S EPA ID Mumbo <br /> 21st Century Environmental Management of Nevada LLC .6 EPA 1O89mber <br /> 2095 Newlands Br.f=ast, <br /> Fernley NV 09408 (775)575-2760 <br /> Fackhry's Phone- <br /> Ra. <br /> honega. 9b.U S,DOT Descriplian(trt Akrg Proper Shipping Name.I lazard C;Ss.10 Number 10 Conlainers <br /> HM and Peeking Group(it arfy)1 1 t Tola€ 12 Unto <br /> No. Type 4uanGly WI,rUol, 13. Waste Godes <br /> }. QN195D WASTE AEROSOLS 2.1 <br /> U }( 331 Doo1 <br /> d i OF 107 P -.,. - . .._ ..__.-.... <br /> z <br /> vX err,-- mtrz <br /> X <br /> "as DOW <br /> u LIM <br /> 4. ON1993 WASTE IFLAMMABLL UQ111DwN.O.7S.,[KE/ROSE -, IESEL) Glt <br /> 1 DF a4 P f <br /> O'1U7 f Dnt6 D0.35V <br /> f1 SpeolalNarift InslruclionsandAd0ionallnRormalian <br /> [1}HLAEgQSOLS-i13•EAG(i26}BLAfApSOLS-f33-AEfiQSDLS t <br /> (4f SLFI.AMLIQ-Q3-ERG(1261 FLAMMABLE IJQtMDS <br /> 1§, GENERATORWOFFEROR'S GERTiFICATION: I hereby declare that€Ere contents of[itis const nmertl are fully and accurately described above by the proper shipping name,and are classified, <br /> marked and tsheWiplacarded,and are in all fe primary d <br /> spec(;in fxaper cpr�1i1i8rt for transport according fe appllryble tatemalronal and national goaemns°nlal regulations.[f export stlipmenl and I am the Primary <br /> Exporter.I cerrifp that Ffle conterfls of tins C011*rra11100009m to the ienm of the aththed EPAAcknaw( UfMnt of Consenl. <br /> I mr(ily that the waste rrdnimizolion staleimpt idenitf n d4 CFR 26227(0)(if t asr a a r}e quant ty generator)or(4J(it I am a smelt quargily ge rentor)is hne. <br /> e alar'' erornn <br /> s PledfTyped Name e <br /> j ay ear <br /> 22 <br /> tern t- +pmenEs ❑ <br /> z <br /> law]10U.S. ❑Exportfrdmll.S- Part ryfexil: <br /> TrarL er «: fs3rex Isom {J eleavr U.S.: <br /> w 17 Transporter Acknowladg rent of Reoeipl of M3teriat5 <br /> Transporter 1 PrntedlTypedName lgoatu on; <br /> aY ear <br /> (L Oarryf Johnson i 9 ' 22 f 17 <br /> Trarrspoder 2 f r Katt yped Name <br /> oa ay Year <br /> 1B Llscreparrcy �/ �`7 <br /> 1 da.OiScrepancy Indication Space I""`} ❑ ��11 f 7 <br /> !.._! Ouanlily Type ❑Residue L--1 Parlcal Rejection U Fred ReleCWA <br /> � <br /> trfan test Reference Number,18b.Alternate i�achicy(or Gealeratorp U.5 EPA IU Numbr:r <br /> U <br /> Q <br /> r-r- Faci6 's Plwne; <br /> 18.Sgna#ure ofAlfemate Facil y(or Generafar) <br /> vonth flay Year <br /> z <br /> 18.Hazardous Waste Re orE Man <br /> "I P agemesll Meq Codes(i.e.';Odes VIrazardars waste treatment.disposal,and recycfing systems) <br /> Lu <br /> o t' 2- <br /> H141 4 <br /> H141 <br /> Tp.Design 11.0 Facility Ownerar operator:C,Cddieafion of(ecelpf of haza does mateciais covered by the manifest except as noted in Hem 18a <br /> Prinfedl3yped Nance <br /> Signature Month Flay Yea <br /> EPA Form$700-22{Reu.3-05) Previous editions are QhsDiefeLA <br /> - <br />