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Please print or type.(form designed for use on elite(12-pitch)typewriter.) 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 CAR000251603 IL 8775772669 008553826 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Dollar 'Tree DC #DC4 Dollar Tree DC#DC4 2099821444 1122 Runway Dr. 1122 Runway Dr. Generator's Phone: Stockton, CA 95206 Stockton, CA 95206 6.Transporter 1 Company Name U.S.EPA ID Number Stericycle Specialty Waste Solutions Inc MNS000110924 7,Transporter 2 Company Name la ^ / U.S.EPA ID Number ow J 0W 8.Designated Facility Name and Site Address U.S.EPA ID Number, S` lT-v/Sal , Cv1�3� .i1°M+�u. r4 Facility's Phon, J W F7Z� 9a 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 Wt.Nol. X 1UN3266, Waste Corrosive liquid, basic, 23 DF 06853 P 122 D062 o inorganic, n. o. s. (Calcium Carbonate, Sodium Carbonate), 89 PG II, ERG#154 W X �J1�19S0, Waste Aerosols, flammable 2. i, ERG#126 2 DF 00274 - P 331 D001 c� Non RCRA hazardous waste, liquid (Consumer 16 DF 02704 P 331 Products), 4. 14.Special Handling Instructions and Additional Information 1.100845(Basic Liquids, Corrosive) 2. 100843(Aerosols) 3. 100852(State .Ragulatedi Liquids) 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, 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 EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small qua tity generator)is true. Generator's/Offeror's Printed/Ty ed Nameigna ure on ay Year f_Gt x-v� L:` �- �& 08J, 30 201 -J 116.Intemational Shipments F. ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature ontWray-75-r i 0M Isidro,Martinez., 081, 301201-7 Z Transporter 2 Printed/Typed Name Signature month Day Year ac 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLJ 1. 2. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year 12rN" l EPA Form 8700-227(Rev.3-05) Previou editions are obsolete. 3l ATED FAr:`U `sr TO DEST?NAT ONSTATE d11F REOUIRED IQILA 70ZiI , 41A04Z30 Q41 920 .91. -M :- ;P'D083017.. SU083017- x