Laserfiche WebLink
.�. � � �; illllllllllllllllllllilillillllllllll <br /> 424739-1'9 002443937PSC 3683609-001 <br /> Please print or type. 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 CAL000397565 1 (877)577-2669 002443937 PSC <br /> 5.Generator's N me and Mailing Address Generators Site Address(it different than mailing address) <br /> ROSS STORE#0826 ROSS STORE#0826 <br /> 101364 TRINITY PKWY 10864 TRINITY PKWY <br /> STOCKTON,CA 95219(209)474-9518 STOCKTON,CA 95219 2094749518 <br /> ' Generators Phone: <br /> 6.Transporter 1 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.US.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and.Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity WLNoI. <br /> 1. <br /> cc <br /> X <br /> Z_ � 2. UN7993 WASTE FLAMMABLE LIQUIDS,N.O.S.(ACETONE)3 PGII <br /> LU <br /> 0 X 331 D001 <br /> 1 DF 32 P --..- <br /> 3. <br /> 4.. ) <br /> 14.Sppecial Handling Instructions and Add6onal in <br /> (1)ROSSAERO-07-ERG(126)ROSSAERO.07-AEROSOLS(2)ROSSFLAMM-07-ERG(128)ROSSFLAMM-07-FLAMMABLE LOOSEPACK <br /> 15. GENERATOR'S(OFFEROR'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 govemmental 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)01 am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> GeneratorslOfferoesPrint Typ Name C Mat - Month Day Year <br /> _j6.International Shipments 8 23 1 19 <br /> F- - Import to U.S. ❑Ex fro U.S. Port o /exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Print edrryped Name Signatur Month Day Year <br /> Transporter 2 Printecirryped Name Signature Mo Dai Year <br /> F <br /> 18.Discrepancy <br /> 111a.Discrepancy Indication Space ❑ Quantity ❑Type ❑ <br /> Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate facility(or Generator) U.S.EPA ID Number <br /> W Facility's Phone: <br /> LO 18c.Signature of Alternate Facility(of Generator) Month Day Year <br /> Q . <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,,disposal,and recycling systems) <br /> LU p i• H141 3: <br /> 20.DesignatedFacility Owner or Operator:Certiticatial of=ipt of haz us materials covered by the manifest.except as noted in I <br /> PrinledtTypedName Si Month . Day. Year <br /> EPA Form 8700-22(Rev.12-17) Previous iUons are obsolete. DESIGNATED FACI 0 EPA's e-MANIFEST 'QT <br />