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481027-1 8" 002047466PSC 3403 -�.^1 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000390053 2 (877)577-2669 002047466 PSC <br /> 5.'Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> ORCHARD SUPPLY#1570 ORCHARD SUPPLY#1570 <br /> 2650 N MAC ARTHUR DR. 2650 N MAC ARTHUR DR. <br /> TRACY,CA 95376(209)662-0192 TRACY,CA 95376 2096620192 <br /> Generator's Phone: <br /> 6.Transporter Company Name U.S.EPA ID Number <br /> STERICYCLE SPECIALTY WASTE SOLUTIONS INC MNS000110924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> GENERAL ENVIRONMENTAL MGT LLC DBA PSC ENVIRONMENTAL SERVICES CAD980884183 <br /> 11855 WHITE ROCK ROAD, <br /> RANCHO CORDOVA CA 95742 (916)351-0980 <br /> Facility's Phone: <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.NoL 13. Waste Codes <br /> 1 ) <br /> ( Z e <br /> W I <br /> IZ 2. NON-RCRA HAZARDOUS WASTE SOLIDS(OIL,IRON) I <br /> 181 <br /> 2 CW 350 P ......µ..____�._.t..._..........._w_,_.` <br /> 3 <br /> 3. NON RCRA HAZARDOUS WASTE SOLID(EMPTY DRUMS) <br /> 512 <br /> 4 CW 500 P <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 41)09tt (2)OSHOILSAND-04-ERG()OSHOILSAND-04-SAND,OIL AND METAL <br /> SHAVINGS(3)OSHEMPTDM-07-ERGO OSHEMPTDM-07-EMPTY DRUMS <br /> 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 export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> 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. <br /> G s/Offeror'sPrinted/lyp Name Month Day Year <br /> l'Z } 12 5 18 <br /> J 16.International Shipments ❑ <br /> ZImport to U. ❑Export from U.S. Port ofentry/exit: <br /> Transporter signature for exports only): Date leaving U.S.. <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> N GUxis-CiBijam mss:- ✓ VIf 12 5 118 <br /> 0 <br /> Z Transporter 2 Printed/1 yped Name Signature Month- Day Year <br /> I- - <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> I+- Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> CD19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJI 01. 2 3. 4. <br /> 6 <br /> d,#9#�- H141 H141 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazar us m erials covered by the manifest except as noted in Item 1 <br /> Printed/Typed Name Signature Month Day <br /> AX <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. <br /> - I ism <br />