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11111111111110H11111 Form ADDroved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 12-17) Previous ediDW are obsolete. V 870@-;-1J2_-12%,,3, C6275723 541086186 04142-7507 '17 1 tU rAt�!Li t PDO60519 t o r -FA b e-rrrArvrrcQ r 6 r Q i circ D@60519_ UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response P7oneT4,anifest Tracking NumberWASTE FLE MANIFEST (^A t�i�04.:�4316 .�7) 57 7—=' ,013120685 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) Famiy Dollar # 31867 Family Dollar#31867 ('229) 924-404E, 2351) S. Airport Way 275101 S. Airpoi-t Way Generators Phone: Rt nrk t n n, rA 95.'1IAA"' 6. Transporter 1 Company Name U.S. EPA ID Number r _ , r _� , 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address` 1 S t Century EMN, LLC U.S. EPA ID Number 2095 Nevilends D . FL4=t Fernley, NG 894$ Facility's Phoney c-2- r G 9a 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt./Vol. wX IN1993, Waste Flammable liquids, n. o. s. 1 F 00007- Fr 331 001 035 0 (Acetone, Methyl Ethyl Ketone) (Acetone, +lflammable, LU� Y PJ1950, Waste Aerosols, (each not 1 F P 331 001 xceeding 1 L capacity)? 2.1, ERG#126 3. 4. 14. Special Handling Instructions and Additional Information 1. 109653 (Flammable Liquids L o o S e pac i<) 2.109646(Aerosols) 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 EPAAcknowledgment 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 I am a small quantity generator) is true. G ator's/Offerors Pdn/t�eldlTyped Nam Sign tur Month Day Year VI p }/�\ /t V _J 106 105 A019 1 . International Shipments Import to U.S. ❑Export from .S. Port ofa try/exit: F ? Transporter signature (for exports only): Da le ing U.S.: a Uj 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name S' natur Month Day Year 00 hV c Z Transporter 2 Printed/Typed Name Signatureth Day Year y ?7 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 V LL Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z N19. Hazardous Waas�te Management Method Codes/(i.e., codes waste treatment, disposal, and recycling systems) 1 2 3 4. /Report ! / �for /hazardous l / / 7-1 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manife#0!xcsi4as note n Item 18a P d/Typed Name r Si u { Month Day Ygar EPA Form 8700-22 (Rev. 12-17) Previous ediDW are obsolete. V 870@-;-1J2_-12%,,3, C6275723 541086186 04142-7507 '17 1 tU rAt�!Li t PDO60519 t o r -FA b e-rrrArvrrcQ r 6 r Q i circ D@60519_