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0 �$ 001827901 PSC <br /> ..3Y3+��fl1-L1C11 <br /> PL-ase pnitt or bjw.(Form des' nod for use on elite(-I -j6h)typewriter-) FomtAppiuveli.OMB No.20�U-0039 <br /> URIFORM HATARaous 1.GEn�or ID Number 2.Page 1 of 3.Emergency Response Phone A.#lani(eStTreclring umber <br /> WASTE MANIFEST CALOM391074 . 2 (877)577-2669'- 1. 001827901 PSG <br /> 5.Generators Name and MaW Addmss CalneraWs S4e Addrm(d riftfent an mating address) <br /> BIG LOTS STORES BIG LOTS#4106 <br /> 300 PHILUP RD,ATTN:DENA FERARU 380 S CHEROKEE LANE <br /> COLUMBUS,OH 43228(61 d)278-270 LODI,CA 95240 20936889 <br /> Generators Phone: <br /> b. ranspoder 1 Company Narrle U.S-EPA ID fdumher <br /> SIERICYCLE SPECIALTY WASTE SOUI110NS INC 141NS000114924 - <br /> 7.Transporter 2Carnpany.Nm* ` l#.SEPAff)Number may.► <br /> $-Des�gnated Facility Name a A Site A&Inns - U.S.FPA W Number <br /> 21st Century Environmental Management of Nevada LLC NVD980895338 <br /> 2095 Newlands Dr.East, <br /> Fernley NV 89408 (775)575--276w- . <br /> FaCif, `sPhOne: - <br /> 9a. 9b.U.S.DDT Desuiplion(including Proper Shipping Nene,Hazard Class,Ip Number 10-OW16rers H.TOW 12.Unit <br /> 1im and Packing Group fifany)} -13.. Waste Codes <br /> Na- Type Quanhry Wt.Akil. <br /> 1. UN2610 WASTE TOA1C,LIQUIDS,ORGANIC,MO.S(2,441)&1 PGII _ - <br /> - _ _ 331 S D016 <br /> - - - - 2 DF 265 P <br /> rZ 2 UNn1%WASTE CORROSIVE LIQUID,BASIC.INORGANIC,14.8.&(SODIUM f yv"OXIGE, <br /> POTASSIUM HYDRDMOE)8 PGII _ - 141 D902 . <br /> OF 13 P <br /> r <br /> S. UN1956 WASTE AEROSOLS 2:t a3t 3 Door <br /> i OF 87 <br /> 4- UN1993 WASTE FLAMMABLE MOUIDS,14.O-S-(KEROSENE,DIESEL)3 PGII <br /> - 1- 2B - - 331�ryDoo1 t 006 <br /> OF p - <br /> D007 301$ DW5 <br /> 1.4:Special Handling inslroftm and Additional Information <br /> (1)aLT`0XIG-03-ERG(153)BLT4)(IC-03-TOXICrUQUIDS LOOSEPACK(2)BLCORf1BASIC-04-ERG(154)BLCORRBASIC-04-BASIC CORROSM LM-IDS(3)BLAEROSOLS-04'-EAG(126) - - <br /> -SLAEFI4SOLS-4-AEROSOLS(4)BLFLAMLIQ-03;ERG(1;8}FLAMMABLE L]QUIDS . <br /> t5- GENERATORWOFFEROR'S CERTIFICATK)N:i hemby declare that the contents of this consignment are hdty and apauately.descrbed above by the proper Oiyphg name,and are cla&Aed,packaged. <br /> marked and Wmmiplacaded,and are in al respects in proper condition kw bans)t acoryrding Io applicable i0emaliotral aridnatimai go,rammental regulaficmS_If exert(shipmeai and I,3m the Primary <br /> Exparier.t certify Ilial the confebts of this consigimentconform to the berms of the attached EPA AclsuOww9m at 4Consent.Oaf ilial the waste mm.miaatipR s lemerd idonkWd in 40 CFR 262.27(a)(ift an a targe quantity generalor)or if i ain a soro qu generato is YA <br /> io s 'nled y re r ay -ear <br /> 1I . 13 18 <br /> z <br /> El <br /> I* IMP60 to ll-S. El Export from us. PO4 of ea <br /> Tran signature fore pn - - - <br /> 17.Transpoftgr AcknawWgmenl of Receipt rrf Materials <br /> Trarnsperterl PfinWlTypedNarre TWIF 03yYear- <br /> IL Darryl-Johnson J. 41 13 1.8 . <br /> X.TtanSpWer 2 Pd*dfTyped Naim SignaM Monthay year <br /> 18 e'screpaocp r� . <br /> 18a,piscrepamGy tndcali0n Space <br /> :1 Como ljType EJR.IdW QPadl li*;('Q ❑FuN Rajoction <br /> maltksl RskrB T Number: <br /> Ab-Attemate Facaity(or Genera%4 U.S:EPA tD Number <br /> �. Facai 'sPhom: <br /> ftJ 18c.Signature of Alternate Faalily for Gemrator)mu Iulpi th Day Year <br /> 14_Hazardous Waste Report Man <br /> � Po agement Meflrod Caiias(i.e:,codes for hazardous waste hraGfsrrt,disposal,and recycling sylenrs) - <br /> �. 1 2 3. 4- <br /> k1144 : HIM H141 <br /> 2f1 Dagrrated Fac Ilry Urvrrpi nr Operator C2rtifieation c receipt 0f Izardousrnat0rial5 covered t ytha manifest ex€ep1 as noted in Item <br /> Pntem - -year. <br /> 6 <br /> a <br /> EPA Farm 8700-22(Rev.3-05) Prevk(1I3s editions are obsolete. <br />