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. - � _ . � 11111111 IVIII[[1111�111I[llllI1111111111111111111111 <br /> Please p A Tint or type.(Form designed for use on elite(12-pitch)typewriter.)• Farm Approved,OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2 Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST101,111U 1n '.� .,�., 008548907 FLE <br /> 5.Generators Name and MadmgAddress Generators 'I.Address(if different than maiimg address) <br /> J r <br /> Marshalls M10122 Marsha!15010122 <br /> ^098527870 22103 Grand Canal 2203 Grand Canal <br /> GeneralorlsPhone• �s�r trt'�: r111. 1 Ft' r"�tit7 Rtrsr�fr�nti_ M tii�,��Gt7 <br /> 6. ransporter1 Company Name U.S,EPA ID Number <br /> Stericvel,n 9nonialty Taste Salutiorls Inc P f itr5, 11M9P4 <br /> 7,Transporter 2 Company Name U.S EPA ID Number <br /> Y <br /> 8.Designated Facility Name and SdeAddress General EnviroTmental Milt, LLC US EPA IDNumber <br /> 11 855 White Rock Road <br /> Rancho Cordova, CA 95742 <br /> Facility's Phone: 9168510980 C€��I'�817f8t�41�3 <br /> ga, 9b.1,13.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and packing Group(if any)) No Type Quantity WtNol <br />' X 1, UN1950, Waste flercisols 2. 1, 5RGfti.26 I CF 90005 P 331 DN <br /> O <br /> LU <br /> X 2, UV1993= Waste Fla milaable liquids, t1. I), s. 1 ,CF 00002 P, 171.211D00' 1031 <br /> (Alcohol, Methyl Ethyl. Ketone), 31 PG 11, <br /> RIM r <br /> 3. <br /> 4. <br /> f '•14,Special Handling Instructions and Additional Information 1. 102333(flerosols) 3.102337(Fl.af ma4le Liquids) <br /> I 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations If exportshipment and t am the Primary <br /> Exporter,I certify,that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I re*that the waste miniriizabon statement identified In 40 CFR 262 27(a)(d I am a large quantity generator)or(b)(if I am a small quantity generator)is true <br /> Generalo aros PrinledfType/Naeigna ure on ay ear <br /> G� on,4)eha of T tX <br /> '� <br /> Y� � � Cr � � YJ�i �• f�k���� <br /> J 16.International Shipments <br /> Z El Import to U.S, El Export from U.S Port of entrylexil: <br /> Transporter signature for ex rts on1 • Dale leaving U 3 <br /> w 17,TransporterkMowledgmenl of Receipt of Materials <br /> Transporter 1 Pdnledrfyped Name Signature onth uay Year <br /> IL <br /> J'arad Marciel �` ] 0'Ji 0: P0:7" <br /> Transporter 2 PnntedlTyped Name Signature Month Day Year <br /> 18.Discrepancy <br /> I Be.Discrepancy Indication Space ❑ quantityyp j 1 <br /> T e Residue Portal Re ection Fall Rejection <br /> Manifest Reference Number. -e <br /> Z3 18b,Altemato Facility(or Generator) US EPA ID Number <br /> U <br /> LL Fa1hl s Phone' <br /> Lo 18c,Signature ofAitemateFacility(or Generator) Month Day Year <br /> d <br /> 19,Hazardous Waste Repod Management Method Codes(i e„codes for hazardous waste treatment,disposal,and recycling systonis) <br /> 2. 3, 4.� i <br /> 20,Designated Facility Owner or Operator.Cerhgcabon of receipt of hazardous materials covered by the manifest except as noted in Item 118a 3 <br /> PnntedlTyped Name � Signature <br /> AA ._, Mor h pav �Year <br /> P} b+"1 """"' `ftp <br /> P Form 8700-22(Rev. -05) Previous edition are obsolete. 6ESIG D FACILITY TO GENERATOR STATE(IF REQUIRED) <br />