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�_ __ - � II�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 424659-19 00244387OPSCIJ ,' 3683609-001 Please-print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000397555 (877)577-2669 002443870 PSL' 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) ROSS STORE#0826 ROSS STORE#0826 10864 TRINITY PKWY 10864 TRINITY PKWY STOCKTON,CA 95219(209)474-9518 STOCKTON,CA 95219 2094749518 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number STERICYCLE SPECIALTY WASTE SOLUTIONS INC MNS000110924 7.Transporter 2 Company Name 1j U.S EPA ID Number B.Designated Facility Name and Site Address U.S.EPA ID Number 21 at Century Environmental Management of Nevada LLC NVD980895338 2095 Newlands Dr.East, Fernley NV 89408 (775)575-2760 Facility's Phone: ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity WENoI. 1,.UN2810 WASTE TOXIC,LIQUIDS,ORGANIC,N.O.S.(LEAD,SILVER)6.1 PGII - - O331 D006 D008 X 1 OF 6e P Q � D011 D016 W Z 2. UN3264 WASTE CORROSIVE LIQUID,ACIDIC,INORGANIC,N.O.S.(HYDROCHLORIC ACID, CW.9PHOSPHORIC ACID)8 PGII 791 D002 X 1 OF 10 P -.-.-_ 3 4. 14.Special Handling Instructions and Additional Information (1)ROSS6.1-07-ERG(153)ROSS6.1-07•TOXIC LOOSEPACK(2)ROSSACID-07-ERG(154)ROSSACID-07-ACIDIC CORROSIVE LOOSEPACK 15. GENERATOR'StOFFEROR'S CERTIFICATION:I hereby declare.thattthe 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. certity that the waste minimization statement identified in 40 CFR 262.27(a)(91 am a large quantity generator)or(b)(if I am a small quantity generator)is true. lator's/Offeror's Pnnt !f ed Name i ature :- Month Day Year 6.International Shipments r c�,r CAka- t 8 23 19 j_ L ❑Impod to U.S. _ ❑Exp rt from IS. Z Transporter signature(for exports only): Date leaving U.S.: W17,Transporter Acknowledgment of Receipt of Materials Transporter Name Signatureer 1 Printed Typetl NMonth Day Year ra L✓. 8 23 19. Z Transport2 PrintedrTyped Name Signatl Month Day Year Or f 2�l 18.Discrepancy 18a.Discrepancy Indication Space ❑ Qn i`?fay ❑Tyhe ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U 4 Facility's Phone: w T&.Signature of Altemate Facility(or Generator) Month Day Year Q 2 F, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal and recycling systems) 1. 2. 3. _ H141 H12114 20.Designated F ciffly Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrinlediT e aamme/ Signature h D W EPA Form 8700- (Rev.12-17) FrireviouS editions are obsolete. DESIGNATED FACILITY TO EPA's e-MA (FEST SYSTEM