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.��� ,� - - IIIIIIIIIIIUNIINIUI[�ullil �: <br /> 5974419 002544237PSC . <br /> slt pri>1Etyfe.` 374j2!-fly.;. <br /> UNIFORM HA ARA(IIlS 7_Gerreratar ID Numtler 2.Pae 1 of 3.Emer nc Res Form Approved Q616 bIO,,'295�Q639. <br /> 9 9e y ponce Phone 4.MaNfest Tracking Number <br /> WAST MANIFEST CAS 001)397555: 1 (877)577-2669 /gyp w <br /> SGenerator's Name,and-Maj Gtig rens VV25442a R.8 <br /> ROSS STORE#0826 Generator s Sde Address(d dReren(than mailing address) <br /> 10864 TRINITY PKWY. .. ROSS STORE#0826 <br /> STOCKTON,CA 95219(209)474-8648 14 TRINITY PKWY <br /> figGenerators Phone: S1.00KTON,CA 952.192094749518 <br /> 6.Transporter 1:CompanyNarrie.._ <br /> U.S._PA ID Number <br /> STERICYCLE SPECIALTY WASTE SOLUTIONS INC <br /> 7:Transporter 2 Comparty Name MNS0001 10924 <br /> W U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address <br /> GENERAL'ENVIRONMENTAL MGT LLC DBA PSC ENVIRONMENTAL SERVICES U.S.PAID Number <br /> 17855 WHITE ROCK ROAD, CAD980884183 <br /> RANCHO;CORDOVA CA 95742 (916)351-0980 <br /> Facility's Phone: <br /> 9a. 9h.U.S.DOT Desc p*(including Proper Shipping Name,Hazard Class,ID Nuriber, <br /> and Pack' Gro d an 10.Containers <br /> HM m9 up C y)) 11.Total 72.Unit <br /> „. 1.. UN7850 WASTE AEF7050L3:22(8} <br /> No. Type Quantty Wt Nol. 13.Waste Codes. <br /> _ - 331 D001.-: <br /> rZ 2. <br /> 6N1 N3 WASTE FLAMMABLE LIQUIDS,N.O S(ACETONE)3 PGr <br /> X - - 331 Ddb1 <br /> . ;.1 OF 15 P l <br /> I r <br /> 14.Special Handlingg IristNdions and Additional Informaian <br /> (t)R6SSAERO07..Egp(12�;gpgSAERO-07-AEpU$pLg(?)gpggFLAMMF07-ERG(128)ROSSFLAMM•p7.FLAMMABLE LOOSEPACK <br /> 15 .GENERATOR'$ietvpl DR'S CERTIFICATION:(hereby declare the the contents of this consignment are fully and accurately described above by the proper shipping name,and are elassitied,packaged; <br /> marked and laheledlplac conte aro are in all respects in propert o he ton for transport accordn9 to applicable international and national governmental re ulat ons.If export sh'meat re c I:srr the P <br /> Exporter,I certthat the contents of this consignment conform to the temrs of the attached EPA Acknowledgment of Consent g p Primary. <br /> . <br /> I certily that the waste,mininipatron ctatementidentified in 40 CFR 262:27(a)(y I am a <br /> Ge t r(Offerors IL. typed Name quantity generator)or(b)(!if am a small quantity generator)is true. . <br /> Signature <br /> Year. <br /> 15.Intematiooal Shipments Y0: 15 79 <br /> Z Transporter signature(for port to U.S. ❑Export from U.S. Port of entry/exit: <br /> e)Wft only): <br /> oC 17.Transporter Date leaving U.S.: — <br /> r ,JI gment pf Receipt of Materials <br /> ransporter i Pnn <br /> Sign <br /> Mr>nih. Day Year: <br /> Tra XPQder 2 Prm ante <br /> Signa <br /> t= MontA.: 'Day Year. <br /> 18 Discrepancy .. <br /> 188Dscrepancy Indication Space ❑ <br /> Quantity ❑Type <br /> ❑Residue ❑Partial Rejection Q Fu8 Rejeiiai; <br /> 184,Alternate Facj i (or Generetor) Manifest Reference.Number: _ <br /> �r U,S.EPAID Number <br /> W FaCBdy's Phone:, ;. <br /> 18t:$ - ue of Atterriste 1-aO <br /> fdy{or Generates) <br /> 2 Month <br /> liazan bus Waste ReportManagement Mettxxl Cartes(te,codes forhrizardous waste treatment,,d' <br /> isposal,and recycling systems) <br /> 1 2. <br /> H141... H141 3. <br /> 4. <br /> 2q Denigrated Owner Pr Operator:Certification of <br /> sped Name recegit of hazardous materials covered by the manifest ertcept as nefed in Item 18a h <br /> ame. <br /> I P 1'FoR11&7022(Rett 121T)Previous editionsa..obsolete. <br /> DES <br /> GILITY TO EPA's e�lk1YST 'M <br />