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584617 19 002572251 PSC_ 3771652-001 <br /> PI e pirlf c ter Form Approved.OMB No.205000.30 <br /> HSPS: t Generator iD Numix l 2.Paye l of 3.Enmrrncy Hespnnse Phone 4.Manifest Tracking Nrdriber <br /> V1tASTEINNIFES CAL000397555 1 (sit)577-2669 002572251 P$C <br /> Ggrp r clot flame aod,lyTading <br /> Address General(%Site Address(if d flerenl ffian nailing address). <br /> AbSS STORE#OSN ROSS STORE#0826 <br /> 10064 TRINITY PKWY 10864 TRINITY PKWY <br /> STOCKTON,CA 95219'(209)474-9518 STOCKTON,CA 95219 2094749518 <br /> 6eneralel Phone: <br /> 0 111 Isporter.I Company Name <br /> U.S.EPA ID Number <br /> STERICYCLE SPECIALTY WASTE SOLUTIONS INC MNS000110924 <br /> 7':Itanspnder''Company.Name <br /> U.S.EPA ID Number <br /> R.Designated Facility Name and Site Address <br /> GENERAL ENVIRONMENTAL MGT LLC DBA PSC ENVIRONMENTAL SERVICES U.S.EP/11D Number <br /> 11855 WHITE ROCK ROAD, CAD980884183 <br /> RANCHO CORDOVA CA 95742 (916)351-0980 <br /> ' farildys i=huipt <br /> ga. 91)U S.DOI Description(including Proper Shipping Name,Ha rd Class,ID Number, <br /> 10.Containers <br /> NM and Packing Group(it Any)) 11.'�otal 12.Unit 73:Waste Codes <br /> No. Type Quantity Wtivol. <br /> LU <br /> jh <br /> UNIgnWASTE FLAMMABLE LIQUIDS;N.O.S.(ACETONE)3 PGII . <br /> .. .. <br /> 0001 . . <br /> - YO ,P. .T <br /> t , <br /> 71'8'haat Nand6nglnstructioas and Additionallnformalior <br /> . (2)AOSSFLAMM-07-ERG(128)ROSSFLAMM-07-FLAMMA13LE LOOSEPACK <br /> t i. ,GENERATOR'SIQFFER4R'S CERTtFIGATIUN:1 hereby declare that the contents of this consignment are fully and accurately described above by Itte proper shipping nao ,ail areclassified, acka 1 <br /> mprked and labelyd/placarded,and are in all respects inproper condilion for UansporCaccordkrg to applicable caole internal Dial and national governmental regulations.If ex p 9e< <br /> Exporter I teddy that the contents of this consignment confomp to the leans of the attached EPAAcknowledyment of Consent pat,shiprrmfit and I'am the Prartaiy., <br /> I canfiy that the waste,minimization statement identified in d0 CFA,262.27(a)-f if I am a ktrgP quantity generator)or(b)(i(I am a small quantlygenerator)is truer <br /> Gc atol'u emesPanferl ypertNamoy , Siynalum <br /> L 1- C 1 / M4n... Day Year <br /> _r } ernatmnal Shoo eats <br /> - �,linpodlo U S. Export from U.S. Port of enhylexl <br /> z Transpwter gnature(tor expnrts only)' <br /> ti rranyponer Ad noYiledt}rtrerit of Recegpt of materials <br /> Dale Ieaving:U.S <br /> 7rin,uortEl t PnnlediTyped Name <br /> 2 Andy Winkl r Signature Month Day . Year <br /> Z hnruporter 2 Pdnted/fyp d.Name• <br /> Signature ; <br /> 11 15 19 <br /> Montt. D,ry Year <br /> - r9 Disr:n�panry {t—�1� <br /> p y !__t Quantity a <br /> El ❑Residue Partial Rejecpon <br /> I .1 Discre�nu hrdlcavon Space <br /> Full Re)ecl¢m <br /> 13b Alteorete FM.16ry(or Getperatrrrj <br /> Manifest Referana Number: <br /> "+ U.S.EPAID Ntm)ber <br /> U - <br /> u�. Facility s Phone <br /> W. kSlgnadure.ofA&emple acdity(orfeneratar) <br /> Z Month Day Year <br /> u�—y 19 H rural ptxs Waste Repnd ARartayement Method Codes(Le., for hazardous waste treatment,disposal,and recycling systems) <br /> 1 <br /> 3. <br /> 0 Designated Facility 0a1 erortJperat6r Cedfie8tldt of receipt of hazardous materials covered by the manifest except as nded n ltam 111a <br /> V. FylpOft film <br /> Signature : <br /> ♦�.. - i egrr.. Pay .Year <br /> FPi%Fflllrr$FUQ'22(t20V:2 IZ) PIPVIOUS ettlhons are <br /> G1 N 'T L`11 ITY ti`LPA's e-MANIFEST <br />