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<br /> Please pool or types(Form designed for u-se an abForm Ale(12-pitch)typewriter.) pproved OMB No 2050-0039
<br /> UNIFORM HAZARDOUS 1,Generator Ib Number 2.Page 1 of 3 Emergency Response Phone 4.Manifest Tracking Number
<br /> WASTE MANIFEST CAR1 0025160, P- 8775772669 008664542 F L E
<br /> 5,Generators Name and Malting Address Generators Site Address(if different than mailing address)
<br /> Dollar Tree DC *DC4 Dollar Tree DC#DC4
<br /> 2099821444 1122 Runway lir. Me Runway Dr.
<br /> Generator's Phone: Stockton. Gid 95216 9tof~ktan. CA 9512015
<br /> 8.Tran$poner 1 Company Noma - U.S.EPA ID Number
<br /> 5ter16ycle Specialty Waste Solutions Inc MIM80 011x0924
<br /> 7.Transports 2 Company,No'a U.S.EPA ID Number
<br /> �/ C >ry',• r:``/!!/� C�' � '7�.-i rr-r~;�. :r! ,�,1� Cr d �7 /a Ca.r
<br /> B.Designated Facility Nome,andSite Address i3en ,ral, 4n,viranigental Mgte LLE;" U.S.EPA ID Number
<br /> 11155 �hi.te Rock Road
<br /> Rancho Cordova, CR 95748
<br /> Faclli Phoae: 91635109130 ' c l 9a 884163
<br /> go, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10 Containars 11.Total 12 Unit 13.Waste Codes
<br /> HM and Packing Group Of any)) No Type Quantity WtNol
<br /> 1. tt�r tit,, ase L;orroSzve liquid, tsasic, 4 DF 00590 P 122 D00a
<br /> o 'inorganic, n. a. s. (Calcium Carbonate% Sodium
<br /> Carbonate), 81 -PS 11, ER@4154
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<br /> 2. t c , asze erosots, t',lammabte 2. 3., Iw b#]E6 2 DF 00156 P 331 D031
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<br /> 3. d; ti, wal3te Pesficides, sa ray voXIC, n. o. s. ad ]]t- viW2411) f- 461. 1 wet
<br /> (Pyrethroids, 1,4-,Dichlorobenzene), 6..11 PG
<br /> .11, I R(3051
<br /> 4U0nSIAl3er h1eCtr0nj0S tar Recycling - CF 00027 P let
<br /> 14.Special Handling Instructions and Additional Information l,„ 1,0084b(Bas'ic Liquids, Garrwosivg) 2. 100843(Aerosol,sl 3.
<br /> 100856(Toxic Solids ) 4. 1008419(Ctrtrsctmer Electronic for Recycling)
<br /> 15,''G ENERATOR'SIOFFEROR'5 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 labelodlplacarded,and are in all respects in proper condition for transport according to applicable intemahonaf and national governmental regulations If export shipment and I am_the Pnmary
<br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent
<br /> I certify that the waste minimization slatemenfidentified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(dl am a small quantity generator)is true
<br /> ens ofs10 erorsPnnleWTyR Name Isignature� � on ay Year
<br /> MVXV� Ica,
<br /> 111 23 1023H
<br /> 1 .International Shipments i
<br /> f- Elimport to U S ❑Export from U.S. Partof ent !exit,
<br /> Z Transporter sInature Lor exports onl • Date leaving U.S.:
<br /> 17,7ransporlerAcknov&dgment of Receipt of Materials
<br /> Transporter 1 PrfnledlTyped Name Signature "�.� on ay Year
<br /> 10 1. 3ityi,oi�trph er Al Mari a l '`Y_ 11 123
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<br /> Transporter 2 Prtn/�ledliyped Name SignaturemonthDay Year
<br /> 18.Discrepancy
<br /> 18a,Discrepancy Indlca6on Spars
<br /> ❑ Quantity ❑Type El Residue El Partial Rejection ❑Foil Rejection
<br /> Manifest Reference Number. '
<br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number
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<br /> LL- FaciNl s Phone:
<br /> 1uj 18c.Signature of Alternate Facility(or Generator) Month ' Day Year
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<br /> r 19 Hazardous Waste Report Management Method Codes(i e,codes for hazardous waste treatment,disposal,and recycling systems)
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<br /> 20.Deslgna ed Facility Owner or Operator:Certification of receipt o hazardous matenals covered by the manifest except as noted in Iten>4Be n
<br /> Pnntedlr p Nam00
<br /> e r Sfgnature / Month Day Year
<br /> (=) i I V" l!'i S (,/ a 0.111'('19 �
<br /> EPA Form 8700-2 (Rev.3.05) Previous editions are obsolete DIrS�IGNATED ITY'TO GEN TOR Si'ATE(IF REQUIRED)
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