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158925-94 Y' IIIUIIIilnllll I 18'II�iIIIIII 1814681-001 , <br /> Please printor ':dell ed for use oil elite f2 Itch writer, .. -FwmADDmn&OMRFb.2050�Q99 <br /> UNlFOIZ1U HA2AR0008•: nemiPtlDNom 9fage4af BFmmgenuy Rtielwrrle Phone - 4,MarIRIlt.,ncgNumber' <br /> WASTE MAr+IPI T CALi)b0374266 ': (ST/)57Z-2669 600757/66 PSC , <br /> Generelae�+ and aalL��A�cidities Gan mare Sl Adea$a Oiflerenl nmab nddross) - - <br /> OLLA[Z ,ENitAL DaLU4�2 GENRAI. 1353 <br /> 4232 E Main <br /> 4232 E Main, Stockton, CA 95215 <br /> Stookton,CA 95215{209) 800-8822 <br /> Gentiles Phoria: U.S.EPA 10 Number <br /> IL Tmnsporua l,Canpany nerve CAR.00029A617 <br /> 21st Century.Env]ronmental Management of California, LP <br /> U.S.EPA ID Number <br /> 7.TmnspoHer2Company Nemo tNi-AA9219a9eR9BAt-�-P•}e*iadal-�k.$—®a.2. 6' q„�— <br /> 8.Do$qnawd FedatyName find 5UAddress U.S.EPA IO Number <br /> 21st Century Environmental Management of Nevada LLC <br /> 2095 Newlands Dr East <br /> Fernley NV 89408 .(775)575.2760 NVD980895338 <br /> Fade Phone: <br /> 9a. 9b.U.S.DOT DesalpNan 0r k dhg Paper r.,#Ing Name,Hazard Class.D Number, 10.CorlDinem 11I. 1 13 VPede Dodos .. <br /> HM and PeddiI Group IN my)) No. TSPti Qum* wUft <br /> DOM 391 <br /> X <br /> UN1950 WASTE AEROSOLS 2.189+4P442"- 1 OF 6 P ' <br /> w 2 <br /> D002 . 172 <br /> CO )( _UN1791 WASTE HYPOCHLORITE SOLUTIONS 8 PGIII 1 DF 3 P <br /> • 3 DMI? 7M <br /> UN3284 WABTE CORROSIVE LIQUID,ACIDIC,INORGANIC,N.O.S. 1 DF 4 P <br /> X. (HYDROCHLORIC ACI D,PHOSPHORIC ACID)8 Poll ' <br /> BATIES,DRY,SEALED.N.O.S.(ALKALINE.BATTERIES)UNIVERSAL WASTE 1 DF 10 - D <br /> TER <br /> 14.Spedol Hwang cUgnsanciAddllbne tion - <br /> '(11DG2.7-01:EROf1261 AEROSOLS(21'DGBLEACH-0I-ERG(157)BLEACH,LIQUID(3)BOSAI.01-ERG(184)ACIDS,INORGANIC(4)DGALKBAT.g1.•�RGQ <br /> TTERMS,ALKA IN (UNIVERSAL WASTE) <br /> 15. GENERA TOR'SIOFFEROR'SCERTIRCA7tON:I hereby dealers Natft comma ofthis comlOnreamam fudyand ecaae'stydesumed above by the pmperddppbV rum.and see dosdr!4p4 . <br /> marked and labe'edlplacerded,end ea N a8 mspocb an <br /> in paper condition for aaordirg to aWmblo international and asters]governmental regulations.H 8aporlah1pmw elq l sm the Primary <br /> Faponor,I owdy8ralma conlenb of this consgnmantconform be the terms oftheatladrad EPAAdnaHledgmantofConmet. <br /> I corgfy tuddie wells miNmlmtbh statement identified h40 CFR 282.27(a)(8l sm a terga QuanLYygerrerator)or(b)(ti oma small 9ueMty generator)is We. <br /> SgneWn .• Moan Y: <br /> #13 93 r eckVla ',j98e LLC on behalf of-DOLLAR GENERA S' <br /> 16.Intematlonal Sldpmeals <br /> ❑Mpo4b U.S. ❑FipeA fan U.S. PM olenby/adt ; <br /> S <br /> Transporter algrabue(for experts only): Dae leaving U.S.: . <br /> 0' 17.TmmpaterAduoh& "*tot RecelptofLtom is - <br /> nrrsvort r 1 me Sgnaare - Month :Day .Yeas <br /> eancTerp9e"Q iadm <br /> Z '.'Matdr._.P,ar••.Year'). <br /> 4 ens r 2 Pdr*WTY*Nam <br /> e ' <br /> 18.Discrepancy <br /> t J <br /> 18a.Mum;arricyindicaeonspace p Quessey ❑>AY 1 '8 2015 ❑`ealdUe ❑P�Ooit*csm _ ❑fin' mat i i. <br /> ManBastftefea wNmnber. 1 " <br /> 18b.MW,*Facility(or Gernentnr) ENVIHMMIAL <br /> - 'US.EPAID Number � ' <br /> HF.CIT1-InCDA1DTAACNIT <br /> ua. Facri",Phones ' <br /> I8c.Signature ofIenmleF ry(or Gecorater) -�; `•���• <br /> is.Haeadousmta Ra;M=gemna McBmd Code$OZ.;Codesfor MrArdWe'westa boabnent:ftosaland mwft aYarema) vc ''•i?i..:�?�,ate. >:+•[.YtY t',.:.?e:`� e".r- „ . <br /> {� <br /> H141 <br /> . 12g.Designated FecSy Ovmei.oi0peiaW!'CongNatlanofleWlptofharar4orumataPala wYers'dlr/Pro masileNeaSeptwrped lnlWnlBe i+'+ n'�I'•ti'4 rr d .p .M, r• � b g. <br /> 1 araDdnyPed Name Y a m r a r o <br /> .. .....1'i r .� � % C ..Y 5 t v #-` l ti :�d{- . r• a <br /> n'11G t d <br /> EPA Form 8700.22(Rev.3051P.nR�[a19edI8OnA'drd.0l>soi91@:',” ",:r...•. ^ >` . <br /> ...: 4`,.....::,.::. .',, . abs: w S v - n 4 c• r r. �k X %'4x tip, <br /> ` <br /> 4`,�.... "y;�•.. r ''� u �e .. ... , .x...a.. ._. ...?�:C °?`''al�1?7TS•�.�t s.B'�tom, ...fw ..,>� <br />