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_ IIIIII <br /> F �I III I I�II II II II�III I�NIII I III I I III <br /> 057994-20 002671435PSc 3865821-001 <br /> Form Approved.OMB No.20-SJ-0(;`;) <br /> j?ii9,=. e riot or tj+p0. <br /> UNIFORM HAZARDOUS I Generator IU Number 2,Paye I of 3.Emeryency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000397329 1 (877)577-2669 002671435 PSC <br /> 4,.Cr`nel aka R Name.and Mailiny Ad(In-ms - Generator",Site Address(it different than mailing address) <br /> ROSS STORE#0035 ROSS STORE#0035 <br /> 5756 PACIFIC AVE 5756 PACIFIC AVE <br /> STOCKTON,CA 95207(209)957.6202 STOCKTON,CA 95207 2099576202 <br /> Genetotors Phone: ilS EPAIU Number <br /> 6.Tr;rastx,rtcr I Company Name <br /> 110924 <br /> STERICYCLE SPECIALTY WASTE SOLUTIONS INC MNS000177 t 'All)NumhCr: Numher <br /> 7.Tran_n(:tl;�r 2 Crrnpany(dame � _ - <br /> 8 Oe';ignakad Facility Name and Site Address U.S.EPA ID Number' <br /> GENERAL ENVIRONMENTAL MGT LLC DBA PSC ENVIRONMENTAL SERVICES CAD980884183 <br /> 11855 WHITE ROCK ROAD, <br /> RANCHO CORDOVA CA 95742 (916)351-0980 <br /> flo US DOT Description(inclu(iing Proper SNppmy Name,Hazard Class.IU Number, 10 Containers I].Tota! 12 Unit '13.Waste Codes <br /> No. Type Quantity a/Vol. <br /> iM1�, ar.d Pas&.ng Group(if any)) <br /> '!- UN1960 WASTE AEROSOLS 2.2(8) 331 % D001 g4 <br /> r X 1 DF 1 P.. <br /> Q <br /> '. UN1993 WASTE FLAMMABLE LIQUIDS,N.O.S.(ACETONE)3 PGII 331 D001 <br /> u X 1 DF 8 P <br /> ~� 3$$ <br /> g <br /> s <br /> b f <br /> t <br /> t <br /> E!ant8ing Inshiitlions anal Additional Intonnaiier: <br /> (1)ROSSAERO-07-.ERG(126)ROSSAERO-07-AEROSOLS(2)ROSSFLAMM-07-ERG(128)ROSSFLAMM-07-FLAMMABLE LOOSEPACK . <br /> GENE RATOR'SIOFFEROR'S CERTIFICATION:1 hereby declare that the contents of this consignment are fully and accurately desr,Ted above by the proper shipping name.and are classified,packaged, <br /> manked ar!d;�he!edlplarartled,and are in all respects in propeccondilwn for transport according to applicable international and nal! I govern ental •gulalians.If export shipment and i am the.Primary <br /> Exp rt-r.I rertdy!hal vi onlenf s of the conl4rimenl conform to 1116 terms of the attaches!EPA Acknowledgment of Consent. <br /> 1 cr.1!y that tot;1naste minimization statement identified in 40 CFR 2G227(a)(if I ani a large quantity generator)or(b)(if I am a s a uantity net or)is true. <br /> Siynatur Month Day Y(r <br /> typed N+ F 2 3 20 <br /> ,f•Intrrn'+tti)n,tl Shipments {{--� S. <br /> ❑Export from U.S. Port of enitylex: - ._.. ..-. <br /> I.- <br /> Ellmporl.U� ---... <br /> z 1 n .I:+,p stare(for experts only): Dahl leaving U:fi.'. <br /> i f s tiprraor^ kn.tf ctgment of Receipt,of Materials Month thy. Y:ra' <br /> i ansponer 1 Pr:l!eo+fyped Name Siynahue <br /> 2 3 20 <br /> AndyVinkler <br /> Month nay Ye.n <br /> 2 )!arr,po,1e ?r,n tedflyred Name Signature <br /> �1 <br /> 8.DisvPivi- <br /> r.>Y <br /> t-- <br /> ,P t Discrepancy c y Ino eat!on Sparc ❑Type ❑fiesirlue ❑Partial Rejection l.!Fu!i Reiedinn <br /> Quantity <br /> Manifest Reference Number: <br /> . U.S.EPA ID Number <br /> lift.A4tnwale Facility(or Generator) <br /> Zi <br /> ,moi. `ra�,''.fysPl,+,na: - Monftr ,Day Ynaf <br /> w <br /> 1Lc.Signature(Tf Alteinate FaC(lily to!Gene@t(AI <br /> F. <br /> d <br /> S2 ,,H;i?n:"d'(i5:"dE1St::RFprut Msnagement Method Codes(i.e.,codes ten hazW(IOUs waste treatment,disposal,and rrcyriirsg syitP,nlS) <br /> Enr),d! <br /> 141 H141wfieror Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18, Month DaySignature <br /> [i A t o m Rrt?'?(Rev.12-17) Pretiioua editions are ohsofete. 0 SIG D FACILITY TO EPA's e-MANIFEST SYSTEM <br />