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273671-16 <br /> 3257350 <br /> Please print or type.(Form designed for use on elite(12-0tch)typewriter.) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUSri7G�,.—.�Ior Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000078500 3 (877) 577-2669 000227198 DAT <br /> 5.Generators Name and Mailing Address Generators Site Address of different than matting address) <br /> XPO Loqistics Freight, Inc. X.PO Logistics Freight, Inc. <br /> 5475 S. RIRPORT VBY 5475 S. RIRPORT UAY <br /> Generator's Phone: STOCKTON CA 95205 (204)483-8283 ISTOCKTON CR 95105 <br /> 5.Transporter 1 Company Name US.EPA 10 Number <br /> STERICYCLE SPECIALTY WASTE SOLUTIONS INC PINS000110924 <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> 8.Designated F-Tdyy Name and Site Address U.S.EPA ID Number <br /> 21ST CE11TURY.ENYIROMENTRL floNflG imIENT OF NEVfn, LLC <br /> 2095 Newlands Drive East <br /> E splwne: FERNLEY, #tin U94UU (775) 575-2750 NVD980B(35338 <br /> ga. 9b.U.S.DOT Desorption Cvxkx ng Proper Shipping Name,Hazard Class,ID Number, 10.Conlatners 11.Total 12.Unit <br /> HM and Packing Group(d any)) 13.Waste Codes <br /> No. Type Quantity WWol.. <br /> a 1• HON-RCRR HAZARDOUS UASTE LIQUIDS URTER-BRSED PRO➢UCTSI ` DM P <br /> 331 <br /> LU 2. NON-RCRR HALIQ <br /> HAZARDOUS URSTE UIDS URTER-BASED PRODUCTS) 331 <br /> DN p <br /> 3• NON-RCRR HAZARDOUS URSTE LIQUIDS (URTER-MSED PRODUCTS) <br /> I DM � �n P <br /> 4• NON-RCRR HAZARDOUS UASTE LIQUIDS NATER-IRSED PRODUCTS) 331 <br /> D19 l J p <br /> 14.Special Handling Instructions and Additional Information <br /> (1) CYFNRIL?-03 - 0;2672/751787903 HOP, (1) CUFRULI-03 - D143150/1571371BO HON (31 CUFNRYLI-Or - 043151/757737180 NON <br /> (4) C04RBLI-03 - 043162/41737180 NON <br /> 15. GENERATOR'SIOFFEROWS CERTIFICATION: I hereby declare that the contents of this consignment are fully and ecauatelydescnbed above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in a4 respects In proper condition for transport according to applicable intemational and national governmental regulations.9 export shr nt and I am the Primary <br /> Exporter.I certify that the contents of this consignment conform to the terms of the attached EPAAdrnowledgment of Consent <br /> I certify that the waste mlnim¢ation statement IdeMitied in 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(if I am a small quantity generatDrl is VT. <br /> GeneratorslOffemes Printed/Typed Namei 1 1 r Signature _ Month Day Year <br /> --r 16.International Shipments <br /> r- ❑Import to U.S. ❑Export from U.S. Pat of entyfept• <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.TrasporWAd nWadgment of Receipt of Materials <br /> oT spaterl PdniedlType�N me Signature ih pay Year <br /> Q Transpoft 2 Ptinted/Typed Name Signabde Month Day Year- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indicalion Space ❑ Quan <br /> tGY [:]Type El Residue El Partial Refection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> L Fac®tyfs Phone: <br /> 1tic.Signakrre of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes Pe,codes for hazardous vrasle treatmmil,disposal,and recyclifg systems) <br /> ILI� 1 2 �l�l 3 V ' 4 � [ <br /> 20.Designated FacF4 Owner or Operator.Ceff-bon of receipt of hazardous matVW3 covered by 0he row& except as noted in Item 19a <br /> p Name Signature Month Day Year <br /> EPA Form 8700.22(Rev.3.05) Previous edi(wns are obsolete. DESIGNATED FACILITY'TO DESTINATION STATE(IF REQUIRED) <br />