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Please print or type. E; I,�111»l�t,�,,; t �t � r Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 ofN77) mergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST GAL0004117,4670 & 577—r`.,6�sc' Q14903435 FLE 5.Generator's Name and Mailing Addressgt t n:James T unn e y Generator's Site Address(if different than mailing address) Walgreens Wal rheen 13994 (209) 467-7861 t04 Wilmot did, 5th Floor, MS #1450 1528 E. Freemont St. Generator's Phone'. Deerfield, IL 600 153-46 18 Stockton., CA 95205_•4 i B 6.Transporter 1 Company Name U.S.EPA ID Number Steric c le Specialty Waste SOltttiODS Inc: �7NS001�'1109 4 7.Transporter 2 Company Name U.S.EPA ID Number 8,Designated Facility Name and Site Address e I St Centur , U.S,EPA ID Number 20,35 Newlands 81^. East Fernley, NV 8940a Facility's Phona.7 55 75276 mVD9808`:it338 ga 9b.U.S.DOT Descriptlon(induding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) Nc. Type Quantity WI.Nol. 13.Wase Codes � X 3N3243, Waste Residue Last Contained, °F 0.00r3I P 311 001 Medicine, solid, toxic, ll s. (War^far'in), . t ISG 11, ERG#151 2. LU c� 3. I 9 4. t 14.SpecialHandlingInstructions and Additional Information I. 113080(SLan.StatUs Determination Includes Container Wt. ) CNT-. 15 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,aril are classified,packaged. marked and labelediplacarded,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. rtify 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. YTIO,fferors Printe Month Day Year morld k co' eas ; ,_j 1 .Inemationa4Shipments El import to U.S. [:]Export from U.S. Po f trylexit: ransportersfgnature(for exports only): i ving U.S.: 17.Transporter Acknowledgment of Receipt of Materials LU Transporter 1 PrinledlTyped Name ignatureMonth Day Year O 0 - 01 15 12121 co Transporter 2 rintedfryped Name re Month Day Year 18.Discrepancy 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: F 18b_Alternate Facility(or Generator) U-S.EPA ID Number J U Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a a 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4, 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a PrintedlTyped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-NIANIFEST SYSTEM r nt drfd ihi i!:� r�4 P7tt7r� r"i�i r,- ribLi Q'T IQK17 hi nno1 1 mai Cnihi i 1-1-Di