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00 <br /> 53$895', 1III1IlIIII111Nlllllllllllllllllllll _ <br /> co �- Please pr,nt 00 <br /> OUNIFORMH ° 0025nn 15]PSC r * e� © N <br /> yt'A57E MA�jy,E': I Gerie.nlnr to N,mner 3743529-001 0) <br /> N 5.Generators Name CAL0003g75551.1Forth Approved.DMFS Nd.2050 iN139 -001 <br /> (',}� 1.P.ry¢ 3.e,ry¢rycncy liespon5e Phone A Menifcyl TrsWng Numbx ^ <br /> ,fTOSS STOREand faeirvr9 Arltlres, (877)577-2669 <br /> COLf) �G6z6 T 002544157 PSC <br /> 0 3�'18647RINf7 I PI(ypy Genemtors she Address ld d'dferenl ln...... ead,essl 1 SC <br /> O 1— STOCKTON,CA <br /> ROSS STORE#GM 9 <br /> N Gerreraiors Phone.- 21pr )4>4.9518 10864 TRINITY PKWY s <br /> N a rrenspdrlcrl Company Name STOCKTON,CA 952192094749618 I <br /> � STERICYCL I <br /> 7 rrartspoder2 Com SPEC1,LTY WASTE SOLUTIONS INC Us EPA IDNumber <br /> fishy Name r <br /> -0 � � MNS00011E8i24 <br /> L 8_Aril 11 Nuhe= <br /> Nema Us EPAIDm1 <br /> a <br /> 21st Cent. Envl sadanPAddmss <br /> N 2095 Newlands Dr @ast7" 1 MaingrSIGMerlt of Nevada LLC J EPA iD Numhe= i <br /> U Fn !pyj,nNY 89408 (775)575-$760 NVDSB0895338 ' <br /> HM andp mOt Descrysl f-luddlg rio t <br /> k'gGWtd yll per Shipping Name,Ha110 CWss,ID Nlxnher, �y <br /> 10.Contaners 11 Io1N 12.Unit 1 <br /> Q 7. rrIVI810 WASTF TDr(JG LIO[8 I No. Type Q-1dy WI Nat. 13.Waste LpdeS <br /> x G8,ONGANIG N.O.S.(LEA G,$ELVER 8,y✓'GTI <br /> t <br /> on"' <br /> IDDI W 2 T <br /> OF 116 P 331 —i <br /> C7 Dn11 0016 <br /> 3. <br /> t <br /> a. <br /> HylSMw0alHand "rw!flans andgddlwnal Infnrmalion <br /> f -0'7-EflG(T531 ROSg&T-07.'i LODSEPACK <br /> 15- G rkeda OR�OfFEROR'S CERTIFICATION:1 hereby decfam That the contents of Ihls consignment are fully and aucuralaly desaihe.adrne by the proper Shipping name,old art clasyiped,packaged, <br /> markedarq]IaGelerilplararded,and a2 in ail res eels in <br /> P pr9percundflidil£er lranSi according to APPkable intemaponaland nahwral gavemmenlal regWalions,g expurt shiparen!and I am the Prrcnaly <br /> Enporfer l Cerli7y foal the romenls ordlis ronsignmenl CanhNm to Lhe Terms of the agached EPAAcknOwled <br /> f Cedily fIEaC the waste minirnizalinn 5alemenl aienlifred in 40 CFR 26227(a)(ir!am a la a gmertl of Consent. <br /> Signi <br /> Gerpr's Pooled?y�t�d rJafne rtle q antdygenerala]or{b){it!am a small quanlly generator}is True. <br /> I6_)n1Month Day year <br /> PmaUonal Shipments <br /> ~ ❑Impo4 is Us 10 15 19 <br /> ? 7ransporl9,Sig nalura(for Lm",.only): ❑Expdd ham U.S. Port of enlryle�iL <br /> w 17.7ranspoAergL&rlow)edyrnA,g of Receipt of Malenals Date leaving U.S.: <br /> oTransporter I Pnnted/rypg]Nalrre <br /> y Ory GldS31 } -f i^ T Signal ag <br /> - Transporter 2 ProntedfT .' ,✓ Month Day year ` <br /> sped Name it <br /> Signature 10 15 19 <br /> U 18.Discrepancy <br /> Month Day year <br /> 1&T.Discrepancylndicallon Space <br /> Q ❑4uantdy ❑type <br /> Rasalue ❑Padiat Rejection <br /> � El Fuli Rejection <br /> C) T�Mernale Facility mbe <br /> {or Generator) <br /> � Mdnifest Reference Nur. <br /> LfV U.S.EPA 10 Number <br /> >, r1 Facdrtys phone: <br /> FI&Srgnafue atAlfemale Facifily(Or Generale) <br /> .�. a Month Day Year <br /> 16 Waste Repan Management Method Codes(i.e.,codes foo hazardod rec <br /> us waste tre3tmerN,disposal,and syslemst <br /> y ' N141 2 3 <br /> a <br /> 00 rnded f <br /> Fnulay Dlv er ur(]A"Ill:r:Lertircai m Of receipt of Wwdous male els covered 6y the mandesl a cepl as nded m llem 1 Ba <br /> O PrrlrJ%t <br /> Signatdre <br /> O Month Uay Yeir <br /> p/0(122(Rev,f2 T1) Previous editions are Dbsolele <br /> O Ln <br /> GENERATOR'S INMAL COPY = <br /> w <br /> C _ s <br /> LL <br /> N O E U- <br /> N U C <br /> tB <br /> Q� rn W W <br />