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Please print or type. --+ I � N ��IIII��IiHl�lllNllll��IIIII�N�I��111� FormApp roved.OMB No.2050-0039 ERI'- UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000369845 1 (8 77) 577-1266- 74 n F LE 5.Generators Name and MailingA s Generator's Site Address(if different than mailing address) `i Cents Only #177 99 Cents Only#177 (209) 956-4992 1120 E. Hammer Lane 1120 E. Hammer Lane Stockton, CA 95210 Stockton, CA 952101 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number Stericycle Specialty Waste Solvations Inc MNS000110924 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address elST Century EMN, LLL U.S.EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 Facility's Phone:7755752760 NVD96 895338 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. an— azar opts, Non—Kegulated bolids and i DF 0008C P 331 o Liquids (Consumer Products), z 2. W 3. 4. 1 14.Special Handling Instructions and Additional Information Solids) 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. Signature e a 0 cents Only Month Day Year Generator's/Offeror's Printed/Typed Name 9 ` 16.International Shipments F ❑Import to U.S. El Export from U Port of entry/exit: " ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials 12 T n orte6l P'nted/T ed ame Signature Month Day Year 0 �a eG l arc�g e� 081 18 1.002e CL Z Transporter 2 Printed/Typed Name Sig Month Day Year rr 18.Discrepancy 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: H 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U + LL Facility's Phone: i W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q , Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1 2. 3. 4. 141q- 1 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name `tea � / � Signature � � Month Day Year ' EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM }