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Please pent or type. Form Approved:OMB.W 2056.063.9.. <br /> UNIFORM HATARI OUS $� I 1 e m 9.E R nee hone 4.iNa est7rackin Number. <br /> WASTE MANIFEST 1Ci u4 2..age t of ncy <br /> 4�� F LE <br /> s;(3enerators.Name and Mailing Address GeneraWr's MAddre!m(if diffare tthant mailing address) <br /> [3u �#�r31 <br /> f999) 999^'99.99 25@. E Harney Ln 25C E }-(arty e y I..n <br /> Lodi., CA 95242 LIS c 1:, CA 95242 <br /> Genera&8a Phone: <br /> 6.7ransparler 1 Company Name. U.5,EPA Ill Number <br /> Ster'icyele Speciality Waste Solutions Lne NSOOOII0924 <br /> 7:Transporter:2:Comparry Name U.S..EPA 10 Number <br /> 8.Designated Facility Name and Site Address U.S..EPA ID Number <br /> 2095 :Newlands Dry. East <br /> Fernley, NV 99418 <br /> Facoity's Phone;7755752760 N-V D980895 338 <br /> ga. 9b•U.S.=T Desgiption(Muding Proper Shipping Nam.Hazard Clam,10.Number. 10.Conlainers 11.Total 52,Unit <br /> HM aril Packing.Group(if any)] No. T Rllamlity www. 13.Waste Codes <br /> X LIN2811, Was' a Toxic solids, Organic, n.n..s.: 4 CI" 00103 A 141 D007 :D01►0. <br /> (Chromium, Selenium), 6. 1., PG IL, ERG#154 <br /> X bAl2ale Waste Toxic, liquids, rganic, n,0.s.. 1 CF 00020 P 141 I1007 D010 <br /> 'Chromium, Selenium), 6.1, PG 1:I, ERG#153 <br /> D01.1 <br /> X IJN 1950.; Waste :Aerosols 2:.1, ER #126 1 CF 00002 P 331 D001 <br /> 4, <br /> 14.Special Handling Instnudbns:and Additional Information .1..11084 .(T o}tic Solids (RCRA)). 2= 120845(To x i c L i.q.0 i.ds (RQ RA)) <br /> . 110830(Aero saIls Flam iable:J <br /> 15. GENERATOR'S10FFERDR'S CERTIFICATION:1 hereby dadare that the mnlants of this consE nmsnt are fully and accurately described z zve by the proper shipping name,ard.are classified,padeaged, <br /> marked and lat>elerYplacarded,cind ora h all respecis'in prepercondition transport according to.applioble internationaland national gov rrirnenlal regulat3om If expart shipment and I ani:the Primary <br /> Exporter,I certify that the contents of this consignment conform to the term of the atiadred EPA Acknowledgment of Consent. <br /> I carfify that the wasle rninimizstion statement identified in 40 CFR 252.27( }(if I am a large quanlily generator].or m a small quanW.generator)is true. <br /> s1Off r Pliated"ryped Name. S ore Month Day. Year <br /> i Y1 051 06: 202 <br /> motion lshipmeffts <br /> . ❑lmportto..U.S. ❑Export from U.S. Port.of entry/bAL <br /> TFaR5pOner SlgnatUn;{for el:pgr(S Dn y]: <br /> Date-leaving U.S:; <br /> aG 17,Transporler Ac uMedgment 0 Receipt or Matarials <br /> U1 <br /> 7ransporter I PrintedlFyped Name Signature Month Day Year <br /> a. Johnny Harper 051 06 202 <br /> Transporter 2 PrirtedtTyped Name Signalu jv Month Day Year <br /> iS:IDiscrepancy <br /> 18a.17 suepancy Indication Space ❑ Ouant iy F-1 Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Numbo <br /> F. 18p.Af.emale.Faci€ity(or Gene`algr) U.$:EPA 10 Humber <br /> J <br /> U <br /> Fac'Uiv.s Phone: <br /> 18c.:Signalure of Allemate Fadlity[or Generator] Month Day Year <br /> 19.Hazardous Waste Re rt Mana ernent Melkbd Codes t:a,sodas for haza. our,waste treaUnerat,di sal,and roc.di s tams <br /> P4. 9. ( �. Y n9 Ys ) <br /> LU t: � 2_. <br /> M.Designated Faddy PWrier or Operator:CMtocat€on of remlpt of-hazardous i naterials covered by the menitest except a noted In Item 1 <br /> Printed d Name t Sonature M Gs year <br /> EPA Farm 87922( ev,12-1.) P.revlous editions are obsolete. 171=8f FACILITY TO EPA's 0-MANIFEST SYSTEM <br /> I�D�5062� SI305.0520 <br /> 3700-22 12v3 C9289207 541087 .73 041..763291 M I <br />