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-- I!ililiil!I1Illfll1111IIIli <br /> 315735-19 3622862-001 <br /> Please Print or-type. Farm Approved.OMR No.205M039 <br /> UNIFORM HAZARDOUS 1.Generates tb Number 12.Page I of 3.Emergency Response Phone 0.Manifest Tracking Nrunber - <br /> WASTE MANIFEST I CAL000397555 1 {877}.577-2669 002360125 PSC <br /> 5.Generik is Name and Mailing fuldres3 Generators Site Address it dptereni than matlhty address <br /> IR08S STORE#0826 ROSS STORE#0826 <br /> 113864 TRINITY PKWY 10864 TRINITY PKWY <br /> STOCKTON,CA 95219(209}474-518 STOCKTON,CA 95219 209474351.8 <br /> Gen r oars Plxme: <br /> 6-TrtrrsprAer i Cohipapy Name U.S.EPA I➢Nrtmher <br /> STERICYCLE SPECIALTY WASTE SOLUTIONS INC JVMMI10924 <br /> 7.Rein, r 2.Company N me .' U S.EPA ID Number <br /> $.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 21 at Century Environmental Managemem of Nevada LLC NVD98089W38 <br /> 2095.Newlands Dr.East, <br /> Fernley NV.89408:"(775)575-2760 <br /> Farartys Plwo.. <br /> 9a. 9h.U.S DOT Descriplirr(intludi tg Proper Shipping name:Hazard Class.f➢Nlunher, - 10.Can augers Tl:Tota! 12..Unit <br /> 13,Waste.Codes <br /> HNI "awl Packing Grow R any}). No. Type Cluar6y NMI. <br /> 1. UN2810 WASTE TOXIC,LIQUIDS,ORGANIC,R-O.S.(LEAD,SILVER`&1 PO61. . - . <br /> .. iY. - 331. 6Da5 nap8 . <br /> O X - - -1 - 'OF-. 54 P <br /> - <br /> - . IHr11DDT& . <br /> LU <br /> ;Z 2, UN3264 WASTE CORROSIVE UQUID,ACIDIC.INORGANIC,N.O.$.(HYDROCKORIC ACID.' <br /> PHOSPHORIC ACID)8 PGH <br /> X- - 1 OF - 32 P ..._...... <br /> S. UN3256.WASTE CORROSIVE LIQUID,BASIC,INORGANIC,N.O.S.{SODIIId HYDAO%IOE,-. - . <br /> POTASSIUM HYDROXIDE)9PCA - � - 122- D002 - <br /> X 1 OF 41 .. P <br /> 11.Spinal Handtrnq Instructmns and Additional Infnrmalion <br /> (1)ROSS&1.07-ERG(153)ROSS6.1.07-TOXIC LOOSEPACK,0)ROS_SA00.07•ERG(154)ROSSACIDLOY-ACIDIC CORROSIVE LOOSEPACK(3)ROSSBASE-a7-ERG(154)ROSSBASE-D7- <br /> ALKAUNEIBASIC CORROSIVE LOMEPACK <br /> 1', GENFRATOR'SIOFFEROR-S CERTIFICATION: I hereby declare that the conlenls of{his cons grxrre Pare fii9 aaa accurately described above by the proper slopping Italne,m d are classified,packdged, <br /> marked coin labeociplaeaNed and areal all respects in proper r ondi€ion For transport accvrdinq to applicable inlemati00af and national gwemmentil regulations.If export shipmeti aid lam the Primary <br /> Exporter:I cedilyy fhat[be-confeds of this cu is gnmeni cnrdurm to the terns d{he attachedft.EPAAcimmledgm"of Cuwlit' <br /> ceAdfy lhai the waste minirnvalionsioamerit ide ilifi d P 40 CFR 281'.,7(a)(I I am a iarge quwflty,gk.—a1M or(b)(Jl-a sinaft q>antdy generalndlis titre, <br /> Ganera{wt Gffero's Pyped Name S tris k9 nth - airy Year <br /> Alv7 16 18 <br /> ,j 15 lWmatponf Shipntenls � ". - <br /> j-. - hripprt to U,S. Export from ll.5. Prxl- entrylexi[: <br /> ? .trans 7n lei signature{Dor expo is ntlyJ: aving U.S, 4.— - <br /> IY <br /> 117,i'IanN3wterAcknavrledq.m@ntofR2r400fM8teriafs .. - .. - . <br /> Lu <br /> Transp xter i PriMediFyped Name S y .. tNonih Qay Year <br /> d <br /> v t <br /> iranspoder Pkaitedfry{ N�rrre 5' atu a Month . Day Yea <br /> '=--- T <br /> Ia.Dxmparlcy:. <br /> 1&1.DScrepascy T]lditWofr Space <br /> 0"4uaelZY Type ❑Res due ❑Fadial Rejeclion <br /> El Rill fWW.urxt' <br /> . _ Manifest Relerenee Number: <br /> ..18a Ahemate Facility(n Gelteratory U 5:EPA ID Nlmber <br /> l F:Ir�tlty5 Pllonp: .. - <br /> Q Ilk S final re of Atc�nale Facrlily(vr.GenerrxJ 6r!N7 Qay. Year <br /> z <br /> :19>Haza uqus W:tsta Report Manayerierl mettwd Codes(I a -codes for hazardous was€e fie merit disposal,and recycling systems) <br /> LU <br /> H141 Ff121H121 <br /> 21-Deny !ecE Facility I m),-r or'Nl angor:1ed7{chlibn tis receipt hazardous ma.'nk covered by the mars excep( nded:t Item 10a <br /> Prntert;Typ S}eat a Month ..�Djay Year <br /> EPA Form 8700.22(.Rev.12-17) revi&s edifl s are a s-fete. <br /> DESIGNATED FACILITY TOEPA's e-MANIFEST S`FST M <br />