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IPlease print or type.(Form designed for use on elite(12-pitch)typewrites) 1.-GeneratorNuForm Approved.OMB No.2050-0039 UNIFORM HAZARDOUS ID��mber Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST t�A R@@@�..e 1 E,@3 8775772669 0 0$5 9 7 6 7 4 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Dollar Tree DC #1704 2@99821444 1122 Runwav Dr. Dollar Tree DC#DC4 Stockton, CA 95206 1122 Runway Dr. Generator's Phone: Stockton, CA 95206 N6.Transporter 1 Company Name Sterieycle Specialty Waste Solutions Inc U.S.EPA ID Number n1 IMNS000110924 7.Transporter 2 Company Name •�+ �� U.S.EPA ID Number y 8.Designated Facility Namnd S'a Address e a rt U.S.EPA ID Number 11955 White Rack Road Rancho Cordova, CA 95742 CI Facility's Phone-9163510980 CAD980884183 9a• 9b.91.1, escription(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers HM anroup(if any)) 11.Total 12.Unit No. Type Quantity Wt.Nol. 13.Waste Codes Waste Clxidizing 1,quid, n. o. s. 4 DF 00798 P 141 001 o (Hen Peroxide, Phosphoric Acid), 5. 1, PGERS#140 W UN1950, Waste Aerosols, flammable 2. 1, ERG#126 1 DF 00058 p C5 331 001 X UN3266, Waste Corrosive li uid basic �! � s 2 DF 00186 P 122 002 inorganic, n. o. s. (Calcium Carbonate, Sodium Carbonate), 8, PG II, ERG#154 plan RCRA hazardous waste, liquid 8 DF 01081 P 331 14.Special Handling Instructions and Additional Information 1. 10@854(Oxidizing Liquids) 2. 100843(Aerosols) 3. 10@845(Basi c Liquids, Corrosive) 4. 100852(State Regulated Liquids) 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, 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. 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 quantity generator)is true. Generator's/Offeroes Printed/fyped Name Signa ure Monthay ear i 16.International Shipments 112 08 016 1--' ❑Import to U.S. ❑Export from Z Transporter signature for ex orts on l p Port ofentry/exit: W 17.TransporterAcknowledgment of Receipt of Materials Date leavin U.S.: Transporter 1 Prints typed Name =Signature A Ph i I !Marcie 1 ont ay ear QTransporter 2 Printew typed Name 112 108 4016 Month Day Year 18.Discrepancy J �^ 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection 18b.Alternate Facility(or Generator) Manifest Reference Number: d U.S.EPA ID Number U Q uL Facilit s Phone: C3 18c.Signature of Alternate Facility(or Generator) Z Month Day Year U) 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2, 3 4. 20.Designate cility Owner or Operator:Certification of receipt of hazardous materials covered by the manife except as not Printed pe ame Item 18a Signa a Month Day Year EPA Form 8 0-2 (Rev.3-05 Previous editions are obsolete. DESIG ACILI T DESTINATION STATE(IFR QUIR D)