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a51^a6 -f 8 <t owmi 166PSC <br /> Please not of (Form lest rted for use oR elite(12-pitdt pewriter) F I <br /> f�(t01 <br /> 14NIF0114 yAZAROOM 1.Generator ID Number ' 2 Page t.o J, mergency Response Plane 4.Mande rackin Ndm4er <br /> WASTE !FEST <br /> CA1.000397.829 f (ST7}577-2669 �O2Q i� �i <br /> 5.. *air's Name and Mailing dress neratoet Site resa fd different than man <br /> adarml <br /> NO�a9 S FC#4iE#0036, ROSS STORE.#003F- <br /> v57S6 P ACIRC AVE 5756 PACIFIC AVE <br /> STOCICTONx CA 95207(209).9574202 STOCKTON,CA 96207.2699516M <br /> r.;ener for Phone-. <br /> r sIx er:4_ . any Name <br /> t+ .fPA1DNwnher : �, <br /> -ST EwN Y&E;SPECIA TY WASTESOLUTIONSiNC IfANS000110924 <br /> Transpc ner z Canpany t;:5..EPA ID Number <br /> R;Des�gthatedF.aCiGty,Nameand dress <br /> , -, h,S:EP0.ID1Vumber <br /> .21stnrtulry F-�tvironmental I�laoa0arrterKof`ltellada LLC IVVD980895338 <br /> 2Q95 Newlands Qr.',E�(st, :. <br /> Femtey,NV 89408 (77-$1-676-270V; <br /> F,Betlity'3 F'aone: <br /> o: fit*U.S.DOT DeSctplton(inol9 PropBr.StiPPin9 Name:tiaZard Class ID Number l0:Ceniaircers 11.Total ;i211ntE' , <br /> 13 .waste codes' <br /> H)rl <br /> :and,Patkit~gGroup(if.anY)1 :, . No T , <br /> 1 'UNh893 WASTE FLANIMA84 E LJOUIDS,N.O.S.(ACETONE)3 PGR <br /> �. 331 :0001 <br /> 7: OF <br /> 86 P <br /> Ar <br /> 2 VN WASTE AEROSOLS 2.1 <br /> � ... �331 ,t10p1 <br /> C7 3(.. T' OF e <br /> 3. LIN2810 WASTE.2OODC;C1GUlO3,ORGANIC;.N.O.S(L:EAD,SILVER)6:1 PGII 831 ;0006 <br /> ' <br /> DOtt ,D018 <br /> 4 <br /> 74.SpeCl< Instructirms and Add'iorial information ~ <br /> (1)tLOSaF[AMM�b ERG(128)ROSSFLA�L81.06-.FLAMMABLE LOOSEPACK(2)ROSRO 06 ERG(126)ROSSAERO 06 110§OL (3)RC1. 6.�118 ERG(163)RSSG 108OX1C <br /> LQOREf Al K <br /> i5.,6ENERATORWOFFEROR'S CERTIFICATION:I hereby declare that the contents of th;consignment are fully and accuraInly described above by the proper shipping name,and are classfiar) <br /> markad and labeled1placarded,and are in aff respects in proper condition for transport acoo*v to applicable international and national gove.nment26regulations:If export shipment and(arii':the(?rlmary <br /> ExpOhter;l celt(ythat the contents of this consignment conform to the terms of the attached F1PP Ackihowledgrrinnt of COnSe 1L <br /> ice ytliat the,waste,mnuni�ation statement: titled in 4g CFR 262.27(a)(t t am a large quantily.Qeneretor):or(b).(if tern.a small quantty gerrerato0ls true. <br /> ;liner s YP <br /> ear, <br /> �► 16'tntemaTional Shtpmenta Imptxt N U.S,* Eltpoft Gbm U S Port of enttylexit <br /> `ran nrsi nature fore tis on :. Oaf" U•&: <br /> a' 17 fransp Acknowledgment of Recei d matsdals <br /> T.tarhsporter t Prntedfjy sed Name g .. Dar <br /> o f 8 <br /> Andy Winkler <br /> W Trensporer 2 Print r . <br /> th, ear <br /> 18:pftfe <br /> r <br /> •.,1 her:Disrxn Ind ,.. � . <br /> 4 t? x space D aratitity []Type E Residue 1�JPartdttiajecthtin LJfult#tel iwn <br /> Manifest f2ofence Number <br /> 1.b.Altemale Facility(or Ckowator) ID Number <br /> U;S.EPA <br /> V <br /> ram Fact s t hone. <br /> aW ,6c;.SignaIuregTAltemate aciliity(orGenerator)':.. Monffi Day Year. <br /> :�� I. <br /> Hazen.WasM1(epon Management Method Codes(re.,:sades for hazardous waste treatment dihsposal and recycling sysbrths),, <br /> a- >; H141 2 Hl.af 3 sf41 4 <br /> iQ.Designated Facility Owner or Operator Cert(ieatiorh of receipt of hazardous materials covered birthe manifest except As(rated n Wattle <br /> Frint yped Name signature, month Day Year <br /> f <br /> Pik <br /> crm 87t 22(W,3-05)'lsfelrious editions ate obsolete. <br />