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i l PleaseTint or p type. Fo11 rm Approved,OMB No.2050-0039 1.Generator ID Number UNIFORM HAZARDOUS CAR�J00278~18 :::7�Page3.EmergencyResponse Phone 4.MaWASTE MANIFEST `' 877577669 013120345 F L E 'IQ5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Dollar General #13592 Dollar General#13592 2098008820 310 W DR MARTIN LUTHER KING JR 310 W DR MARTIN LUTHER KING JR Generator's Phone: STOCKTON CA 95206-1763 STOCKTON CA 95206-1763 `V 6.Transporter 1 Company Name U.S.EPA ID Number Steric cle Specialty Waste Solutions IncI�1NS000110924 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address General Environmental Mgt, LLC U.S.EPA ID Number 11855 White Rock Road Rancho Cordova, CA 95742 Facility's Phone:916,,1510980 CAD98088�+183 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers HM and Packing Group(if any)) 11.Total 12.Unit 13.Waste Codes No. Type Quantity Wt./Vol. X UN1950, Waste Aerosols, flammable 2. i, ERG#126 1 CF 00019 P 33� �D001 o _l Z 2 W 3. 4. 14.Special Handling Instructions and Additional Information .L. 110541 (Aerosols) 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 EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)orb if I am a small quantity O( q ty generator)is true. Generator'slOfferor's Pnnte/Typed Name Signature Month Day Year —j 16.International Shipmentsr� s 1= ❑Import to U.S. ❑ :K Transporter from U.S. Port of entry/exit: Transporter signature(for exports only): W 17.Transporter Acknowledgment of Receipt of Materials Date leaving U.S.: LU Transpo ter 1 Printed/Typed Name Signature oma- Isidro dart i nez Month Day Year QTransporter 2 Printed/Typed Name Signatures 1 19 H Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection F_[18b.Alternate Facility(or Genera(or) Manifest Reference Number: U.S.EPA IDNumber lity's Phone: W Signature of Alternate Facility(or Generator) Z Month Day Year W19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) [> 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature th D Yea EPA Form 8700-22(Rev.12-17) Previou editions are obsolete. DESIGNATED t-ACIL Y TO EPA's e-MANIFESTSYST891