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ERI s v.1� Please print or type. ER a u t<w -n- Td i t 1 Form Approved.OMB No,2050-0939 UNIFORM HAZARDOUS 1.Generator ID Number 2.PageEmergency Response Phone 4.Manifest Trackin Number WASTE MANIFEST ICAL00032426Et %87.7? 577-2669 014 03441 F L E 5.Generator's Name and Mailing Address t t n-.Ja m e E Tun n e y Generators Site Address(if different than mailing address) Walgreens Walgreen#2680 (209) 941-2964 104 Wilmot Rii With Floor, MS 1#1450 15 W. Harding Way Generator's Phone: D e e r f i e l d I L. GOO 15--461 8 S t oc kt u n, CA 95204-5716 8.Transporter 1 Company Name U.S.EPA ID Number (:tear Earth Sneci.zItt Waztt? Solutions IMNS000110924. 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address ?ISt Century EMM, LLC U.S.EPA 10 Number 2095 Newlands Or. Fast Fernley, NU 894CA Facility's Phone: l55 75c 76thNVID9B 1895338 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit M and Packing Group(if any}} 13.Waste Codes H No. Type Quantity Wt.Nol, X WN32491 Waste Residue Last Contained, 1 Cr 00001 1 311 Pool 0 Modicine, solid, toxic, n.❑. s. (Warfarin), W #151 � X 1`13266, Waste Corrosive liquid, basic, 1 F 00007' P 12 01 00 inorganic, n.o. s. (Calcium Hydroxide, ,otassival Hi dr�oxide? 8 Ila 11 EfRC 154 3. 4. 14.Special Handling instructions and Additional Information 1. 1130$@(Bpn.Status Determination Includes Container Wt. ? CNT7 2. 443(Basic Liqttid, Corrosive) 15, GENERATOR'SIOFFEROR'S CERTIFICATION: k 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 Iabeledlptecarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations,lfexport shipment and 1 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 identi€ied in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. en at Offeror's Printed/Typed NameMonth Day Year S'n ure lcql 116 402i -r rnational Shipments H ❑Import to U.S. ❑Exportfr U.S. Port of ent xit: Transpoder signature(for exports only): Date leaviJ6 i W 17.Tmnsporter-Acknowledgment of Roceiptof Materials Transporter 1 PdnledlTypeld-Name Si ature ! Month Daay yYear E. f1l�u fl.SfeS ��.'Gn�.K ti.E 7. .�.4.J 4.Ei ±. ZTransporter 2 Printed/Typed Name Sign re Month Day Year r 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_ V Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems} O 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of reee'spt of hazardous materials covered by the manifest except as noted in Item 18a Printed)Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM 8700-22 12 v 3 C:AI_2f11L7t61Zf 112 C;2-1.37 i 97 R.71 q M 13nm 1 4 r%I,i pno i 1 A p 1