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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000401815 1 1 (877) 577-2669 0196 92129 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Marshalls #M0122 Marshalls#M0122 (209) 952-7870 2203 Grand Canal 2203 Grand Canal Generator's Phone: Stockton, CA 95207 Stockton, CA 95207 6.Transporter 1 Company Name U.S.EPA ID Number Stericycle Specialty Waste Solutions Inc MNS000110924 7.Transporter 2 Company Name _ 1 a. U.S.EPA ID Number �'L7.J,T� ,'y �` _"' � '��',,��`.,,,��!i ��.._ t�U j;1�"y^j'r .<::��✓�'�'f��if 8.Designated Facility Name and Site Address 21st Century EMN, LLC U.S.EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 Facility's Phone:7755752760 NVD980895338 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes Waste Flammable liquids, n, o. s. 2 DF 00085 P 331 D001 D035 o (ALCOHOL, ACETONE), 3, PG II, ERG#128 z 2. w 0 3. 4. 14,Special Handling Instructions and Additional Information 1. 102337(Flammable Liquids) 15. GENERATOR'S/OFFEROR'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, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if l am a small quantity generator)is true. Generator's/Offeror's Prin yped Name Signature baba 1 f T] Month Day Year c E'JIJ. j�lU$)YV r 0131 231201. J 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LLI Transporter 1 Printed/Typed Name Signature Month Day Year a Demarco Brodnax 1081 23 201 QTransporter 2 Printed/Typed Name _7, 2) ' Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U ra+ Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. 2. 3. T- 20. Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest excepVas noted in Ite 18a Printed/Typed Name Signature M Da -Yea-r] la)lsLur I I !CA EPA Form 8700-2 (Rev.12-17) Previous editions are obsolete. DESIGN ACII_ITY TO EPA's e-MANIFEST SYSTEM 8700-22_12v3 CAL40000131 540024565 041514399 M PD082319 SD082319