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Please print or type. <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.P�Z=9-( <br /> se Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST1 —11 1 n13 6573,94 <br /> F L E <br /> 5.Generators Name and Mailing Ad if an mailing address) <br /> Dollar Tree DC #DC4 Dollar Tree DC#DC4 <br /> (209) 982-1444 1122 Runway Dr. 1122 Runway Dr. <br /> Generator's Phone: <br /> GA <br /> 6.Transporter 1 Company Name ID ber <br /> 7.Transporter 2 Company Name r U.S.EPA ID Num er <br /> 8.Designated Facility Name and Site Address 21st Century EMN, LLC U.S.EPA ID Number <br /> 2035 Newlands Dr. East <br /> Fernley, NV 89408 <br /> Facility's Phone: <br /> ga 9b.U.S.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 Wt.Nol. <br /> o X1 UN3266, Waste Corrosive liquid, basic, 3 DF 00362 P 122 D00 <br /> inorganic, n. o. s. (Calcium Carbonate, Sodium <br /> WA. 1 <br /> LU X 2. UN1993, Waste Flammable liquids, n. o. s. 1 DF 0009 P 21=4 D00 D03 <br /> (Acetone, Methyl Ethyl Ketone), 3, PS II, t <br /> s <br /> 3. <br /> ERUIPSi <br /> 4. <br /> f <br /> 14.Special Handling Instructions and Additional Information <br /> 1. 100845(Basic Liquids, Corrosive) 2. 100850(Flammable Liquids) <br /> 15. GENERATOR'SIOFFEROR'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 governmental 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)(if I am a large quantity generator)or(b)(i m a small quant i gen rator)is <br /> Gen or's/Offeror's Printed/Typed Name 1 S' Month Day Year <br /> IX <br /> J 16.InternationalShipments 9 <br /> F ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> rY 17.Transporter Acknowledgment of Receipt of Materials <br /> W <br /> Transporter 1 Printed/Typed Name Signature j Month Day Year <br /> OCL <br /> !1 <br /> Z Transporter mted ype ame Si nature 9 <br /> 9 Monih Day41 <br /> l Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantify El Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> F}- 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> _J <br /> V <br /> LL Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 0, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLJ <br /> in t )q /,.,-)/ I2 P /�-/ 3 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. <br /> 8700-22_12v3 CALS470018 S40031230 041571720 M PD102419 SD102419 <br />