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1��� � (1!�I� �!��� �� ��I��II'Il is l��l�lll! Form Approved OVO No,2050-0039 <br /> Please print or type. Rqsperis--pnone 14,Manifest Tracking Number <br /> UNIFORM HAZARE)O!l <br /> Generator ID"'no" �669 <br /> 1, <br /> 1 <br /> WASTE MANIFEST 2"5j 1603 1 1312496 13 FLE <br /> 5.Generator's Name and Making Address f0i 4ferent nlian mail gadcress', <br /> Dollar Tree DC #DC4 Dollar Tree DC#DC4 <br /> 2099821444 1122 Runway Dr. 1122 Runway Dr. <br /> Generators pno7e Stockton, CA 95206 Stockton, CA 95206 <br /> 6,Transporter I Company Name U S.EPA ED No'nicP! <br /> Stericycle Specialty Waste 501""Un5 Inc IMNS12110171110924 <br /> EPA IC Number <br /> 7 Transporter 2 ConniconyNxTie CAR00017542-2 <br /> Worldwide Recovery SysteMS <br /> 8,Designated Faittilly Name and Ste Address Yi-j m a Yes, LLC <br /> 2730 E. 13th Street <br /> YumEi, AZ 85f365 <br /> Facility's PhDrIe9286428938 JAZR000515924 <br /> 9b.U.SDOT DescriDt;on(including Propar Shipping Name H_,arr IDN,.rnter, 10 Containers I Total 12 U;�;t <br /> 911Waste Codes <br /> Htyi and Packing Group('+,anp,,, Type Quar'N Y y"t"I" <br /> Non RCRA hazardous waste, liquid (Consumer DF 011412 <br /> fl s31 <br /> 0 Products), <br /> 3, <br /> 4 <br /> 14.Special Handling instrL,0ons and Additicpal 11'cirrnar`n 1. 1008520-33tate Regulated L:iQuids) <br /> 15. GENERATOFUSIOFFEROR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and occLirately desor;bed above by the proper shipping name,and are dassited,packaged, <br /> marked and labeiedipsacarded,and are in all respects in proper condition,or transport according to applicable internalcnatand national govemTental 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 EPAAckneviledgment of 4risent. <br /> I certify,that the waste Minimization statement!identified in 40 CFR 262 27(a);41 am a targe quantity generator)a,(b)#1 air a sh`14141� <br /> Generator' Y-a' <br /> Mrtt" Day <br /> '09? is Printedrryped Name 9 7-�- 104 101. k01 9 <br /> _j 16,International Shipmerts <br /> L]Impor-,to U's ert-, <br /> Transporter slgnatsre(Im,exports only), <br /> Cr 17.Transporter Ackricafedgment of,Recti pt of%',derals <br /> crTransporter I PrintelTypedNarrie S�cnat"', von:�' Dar V93, <br /> COL Kristopher Almanza 104 101 019 <br /> Z Transporter 2 PrimedTyped Name 5 gwilure Mc, Day <br /> 18.Discrepancy <br /> 18a Discrepancy Indicat"on Space <br /> Flan sl Reference NLlrrze, <br /> 18b.Alternate Facility(or Generator'? U.S EPA 10 NjmW <br /> U <br /> LL Fachty's Phone: <br /> VIcrim Day 'yearW 16c.Signature of Alternate Fac6ty,or Gene ator) <br /> 19 Hazardous Waste ReportManagemer-NIelhod Codes codes for hazardous waste treatment.ispcsji,and recy4riq systems) <br /> W <br /> 20.Designated Caner ol,Cpeatc' Cer,i6cai un of receipt of i,aza*d.;U5 rrate,as covered by the manifest Kopt rued In!["in 18a <br /> Prirted-I'lpec Name signal' C %1 h Da• Year <br /> 'J <br /> EPA Form 8700-22(R6/ 12-171 Previous editions are obsolete Y S AE <br /> GNA-irm FACILITY TO EMS e-MAN11 <br />