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<br /> 535154-19 002543632PSC 3742652-001
<br /> or Feral Approved OMB No.2.051010fl3ci
<br /> tJN1F0RM'FIA7.ARD0tJS Paye I o! 3.Emergey Rcw-oph, 4��` Manifest Tracking Number
<br /> WASTE.MANIFEST CAL000397329 (877)577-2669 002543632 PSC
<br /> G(ovrnfw s,,31tp Atldre s(if tfidvient tom nnaditill 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
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<br /> I PA ID Numhor
<br /> STERICYCLE SPECIALTY WASTE SOLUTIONS INC MNS000110924
<br /> Number
<br /> lk),!', PA 1D Nurnher
<br /> rNam( and Sito Add- J_0
<br /> 21st Century Environmental Management of Nevada LLC NVD980895338
<br /> 2095 Newlands Dr.East,
<br /> Fernley NV 89408 (775)575-2760
<br /> 0.Contanwi, 11 11*11 1` !Jnti
<br /> Z! fjk,.f"�ulz (,,,;I lfi�r I ward Cass, D Number, 13,VJi,;[,,)Cori(,s
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<br /> 1 UN2810 WASTE TOXIC,LIQUIDS,ORGANIC,N.O.S.(LEAD,SILVER)6.1 PGII 331 D006 D008
<br /> X 2 209 p
<br /> D011 D016
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<br /> accurately above by the plopoi ship In name.ilrxi,"!o dai;',,1fwfI.plickjoed
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<br /> flir!v,(j: 1,2pf,i Name
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<br /> Darryl Johnson 10 18 19
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<br /> H141
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<br /> I� Joj�(i, ,X700?1'Me�,, 12-17) SYTtm
<br /> \��, DESIGNATED FACILITY TO EPA's e-MANIFEST
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