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Form Approved.OMB No.2050-0039 <br /> Please print or type. 3,Emergency Response Phone I f t <br /> UNIFORM HAZARDOUS 1.Generate (877) 577-26613ill 611612" 12 5 F L E <br /> WASTE MANIFEST CAL00036,:7,4 <br /> Generator's Site Address(if different than mailing aaaressl <br /> 5.Generator's Name and Mailing Address 99 Cents Only#177 <br /> 99 Cents Only #177 <br /> 1120 E. Hammer Lane <br /> (209) 956-4992 1120 E. Hammer Lane Stockton, CA 95210 <br /> Generator's Phone: Stocktan5 CA 952 1 L71 U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> Spprialty Waste Solutions Inc MNSOOOII0924 <br /> e <br /> StericyCle U.S.EPA ID Number <br /> I c <br /> 7.Transporter 2 Company Name <br /> Company <br /> U.S.EPA ID Number <br /> 7.Transporter <br /> Fac',1111y Name and Site Address General Environmental Mgt, LLC <br /> 118515: White Rock Road r,:E��:rgency R ponse.Phone, <br /> 111ha, ,all,, <br /> �Ord o V <br /> Rancho Cordova, CA 95742 CAD980884183 <br /> Facility's Phone:9 1635 10980 <br /> "s <br /> 9b U.S.DOT Description(including Proper shipping Name,Hazard Class, 10.Containers 11.Total 12.Unit <br /> 9a, 9b.USDOT Description Proper Shipping Name,Hazard Class,ID Number, 13.Waste Codes <br /> Group <br /> Y)) No. Type Quantity Wt.Nol.. <br /> HM and Packing Group(if any)) <br /> Waste <br /> s 0 S DF 010123-7 P 214 D001 <br /> X UN1950, Waste Aerosols, [flammable, (each not 2 <br /> IL P Y)3 (AerCli� <br /> 0 exceeding I L capacity)] (Aerosols), 2. 1, <br /> exceeding <br /> E B 6 <br /> RB#126 <br /> Z 2. <br /> LU <br /> 0 <br /> 3. <br /> 1 <br /> 3 <br /> 4. <br /> 1 p c, '4 19 <br /> 4.tSpecial Handling Instructions and Additional Information L .913(Aerosols) <br /> this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: Thereby declare that the contents of i sig I Primary <br /> 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 amthePrm <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262,27(a)(if I am a large quantity generator)or(b)(i I f I am a small quantity generator)is true. Month Day Year <br /> Generator'slOffero�s�rintec!/Typed Name Signature 0 1 Vehalf of 99 t 0 <br /> 0131 23 1201 <br /> W V <br /> I <br /> 16.international Shipments El Import to U.S. LJ Export from U.S. Port of entry/exit: <br /> Date leaving U.S.: <br /> Transporter signature(for exports only): <br /> 17.Transporter Acknowledgment of Receipt of Materials Signature 4 Month Day Year <br /> LLI Transporter 1 Print yped Name <br /> 08 233 <br /> Demarco Brodnax Ath Day Year <br /> Z Transporter 2 Printed/Typed Name Signatu <br /> 18.Discrepancy El Residue ❑Partial Rejection El Full Rejection <br /> 18a.Discrepancy Indication Space El Quantity El Type <br /> Manifest Reference Number: U.S.EPA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> L) <br /> tai Facility's Phone: Month Day Year <br /> W 18c.Signature of AlternateGenerator) <br /> !R <br /> Z <br /> 2 Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> U)119.Hazardous Waste Report Management Method 3. 4. <br /> LU 2. <br /> 1 4 \ covered by the manifest except as no <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials Signature M ay Year <br /> PrintedfTyped Name .0-- 1�A t� <br /> I YY DESIGNATED FACILITY TO EP -MANIFEST SYSTE <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. <br /> C2 n 11h Ja P 1.1 11 q <br />