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pw2926-6. <br /> !212-17� ri_ 00170294210SC <br /> P pe-(Form:designed for ase on elite(.12-pitchy tYDewriter.) Form Approved.OMB No.2050 0039 <br /> FR <br /> DOUS 1.Generator ID Number 2;page 1 of 3.,Emergeney Response Phone 4.Manifest Tracking Number <br /> EST CAL000397329 <br /> 1 tsr,)sn-2sss 001702942 PSC <br /> and MailingAddress neratoes Site Address(if different than mailing address) <br /> #0035 ROSS STORE#0035. <br /> AVE 5756 PACIFIC.AVE <br /> STOCKTON;CA 95207(209)9".6202', STOCKTON,CA 9.5207.2099576202" <br /> Generator's-Ptwne: <br /> €. ransoorter . any ame <br /> U.S.EPA ID Number <br /> STERICYCLE SOECIALTY'WA TE SQLUTIUNS)NC MNS000110924 <br /> 7.Trans2orter 2 Company Name / U.S.EPA ID Number <br /> 8.Designated a R' ameand nes _ U.S.EPA)D Number <br /> 21st Cent vit5C11meFitaI Management of Nevada LLC NVD960895338 <br /> 2095 NeWlatfi4tlg <br /> Fernley.NV 8 )1575-2760. <br /> FaclitySf di)i <br /> ga t1.S WT oescription(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers. 11 Total 12.Unit 13, Waste Codes <br /> HM, and Paetung Group(rf any1l No. Type Quantity Wt-MI- <br /> 1 UNY993 WASTE FLAMMABLE LIQUIDS,N.Oz&(ACETONE)3 PGII <br /> 331 D001 <br /> !L' .X 1 OF P <br /> W2:UNI 960 WASTE AEROSOLS,FLAMMABLE.(EACH NOT EXCEEOING.1 L CAPACITY)2.1 _ - - - '331 tN101 ' <br /> C� �( <br /> 1 OF <br /> 25' r P <br /> 3 UN2810 WASTE TOXIC;LKNIIDS,ORGANIC,N:O.S(LEAD,SILVER)6J PGII 331 D006 D00e <br /> X 1 OF 79 P <br /> D01.I 0016 <br /> 4. UN3266 WASTE CORROSIVE LIQUID,BASIC,I_ Rt44 ,N-O.13;( UM HY ) DE, <br /> POTASSIUM"YOROX(0E)a PGh_ S� 1 Y22. D002 <br /> X 1 DF. tl P <br /> 14.S Handtslg tnSU4tdions and Additional information <br /> (1)ROSSFkAMM ,+ (120)FLAMMABLE LOO$EPACK(2)ROSSAERO-05-ERC(126)AEROSOLS(3)ROSS6:1-0.5-EA 1163)TOXIC LOOSEPACK(4)ROSSBASE-05-ERG(154) <br /> AIXALiNElBAi3iQRRCISlYEi00SEPACK <br /> 15: OENFJaATOR SK)EEEROR'S CERTIFICATION:i hereby Aeclare tfiat the contents of this consignment are fully and accurately described above by the proper shipping q'ame,and are classified;packaged, <br /> marked and labeted,0308rded,and are in all respects in Proper condition for transport according to applicable International and national governmental regulations,H export shipment and I am the Primary <br /> Exporter,I certify.that the contents of this consignment conform to the tem of the gybed EPA Acknowledgment of Consent. <br /> certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if i am a small quantity generator)is true. <br /> Ganer s n, re Year <br /> 11 13 17 <br /> -. 6.intent nal Shipments <br /> z ❑Import to U.S, ❑Export S. Fort of entry/exit <br /> Trans rmr 'nature r exports only); fate leav' U.S.: - <br /> W 17.TransporlerFwimowtecgmentofReceiptofMaterials <br /> a Transporter Printed/. Name <br /> ' _ igna ire ay Year <br /> H Chris Gilliam: 11 113 17 <br /> Q Transpoder2P,nntediTyped.NName nate nth a ear <br /> 00-01 <br /> Y <br /> F-. <br /> 18.Discrepanc <br /> 18a.Discrepancyfndicatirm Space Quantity <br /> QTYpe LI Residue,. . lJ Partial Rejection El Full Rejection <br /> t8b.Altemate Facility(or.generator) Manifest Reference Number: <br /> =t . U.S.EPA ID Number. <br /> V - <br /> LL. Faci 's Phone; <br /> LU 18c.Signature ofAkemaki Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1; <br /> 12. <br /> H141 H141 s H141 <br /> 20.Designated Facility Owner or Operator.Certfication of receipt of hazardous materials covered by the manifest except- <br /> 11 <br /> Namaed in Item 18a <br /> P' edSigrrar r th a ear <br /> T! �- --" <br /> "ITA Form 8700-22(Rev.3-05) Previous edipons are.obsotefe. <br /> . -. 7 a Mal-176.7.1 K76 7%d-1VZI_MI-itl ltr7_Jr.. <br />