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"r 4(� 2361 G� X27 42%13 • 8 7 9 3 piwaca�i f nr tu(i!ttr Xnrm rlacinnad fnr usa nn alita f t 9-nifchl tvnawritar) Fnrm Ann -A (IRAQ Rrn MSn-nn,10 tPA corm 8fuu-zz (Kev.:s-tib) Pre ,tion are obsolete. DESIGN4YAD FACILITY TO DESTINATION STATE (IF REQUIRED) 10887.1894 UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Trackin 00770§16 1 JJ WASTE MANIFEST CAL000167732 ( 800) 424-9300 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) Fedex Freight FEDEI( FREIGHT (STK) 4528 SOUTH HI6HURY 99 FRONTAGE ROAD 4528 SOUTH HI6H1AiY 99 FRONTAGE ROAD GenerMOMMI CA 95215 (289)456-2127 ISTOCKTON CA -95215 (209)466-2127 6. Transporter 1 Company Name U.S. EPA ID Number 21st Century Environmental Management of Nevada LLC INVD9808§5338 7. Transporter 2 Company Name U.S. EPA ID Number 21st Century Environmental Management of California LP CAR000210617`-- 8. Designated Facility Name and Site Address U.S. EPA ID Number GENERAL ERVIRMENTAL HIST, LLC DDA PSC £AVIROHH£NTAL SERVICES 11855 SHITE ROCK ROAD Facility's Phone: RMM CORM,CA 9574 () 351-6980 CAD913OBB41133 98. 9b. U.S. DOT Description (indud'ing Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group ('d any)) Quantity Wt.Nol. 1( RCRA HAZARDOUS PASTE SOLID 311 ® DM dC)I P UJI2. NON RCRA HAZARDOUS BASTE LIQUID (LAUNDRY DETERGENT) o� 5fiI- DM P 3. UNIS07 WASTE AL S, N.O.S. (ETHYL ALCOHOL, HETNANOL) 3 P6II ®C1 I (� D00i 212 X DM 0().r P 4 Nei RCRA HAZARDOUS WASTE LIQUID (SOAP) 00 BM DQ P L... 14. Special Handling Instructions and Additional Information ( Ix 2 x V 10 ) Y �- (1) RZSOL-00 - PRO# 2876055553 NON (2) FEFNONHAMIO-09 - PROS 2153580455 NRIN (3) 1`11352-00 - ERG(127) PROS HET -158317 ETHY (4) ZUQ-18 - PROS RKR-535292 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately descries above by the proper shipping name, and are dassified, packaged, marked and labeledfplecarded, 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 EPAAcknowfedgment 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) (9I am a small quantity generator) is tru GeneratotsfOfferues PrintedlTyped Name Sig � Month'" ` Day Year e rlr � •lEr Q 2. 2�t � 16. International Shipman ❑ Importto U.S. ❑ Export from U.S. Port of entry/exit c ~� z Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Aduw)Nedgment of Receipt of Materials Transporter 1 Pdnted(fyped Name Signature Month Day Year Transporter 2 PrintedlTypod Signature hath Day Year 1Z `J Z 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity, F-1 Type F-1 Residue ❑Partial Rejection ❑ Full Rejection Manifest Reference Number. 18b. Alternate Facility (or Generator) U.S. EPA ID Number J V W FadiitysPhone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z 19. Hazardous Waste Report Management McOrod Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) ® 1. 4. TZu, 14I 14*H- 20.esrgnated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as riled in Item 18a Priteffyped Name Month Day Year r M 1V tPA corm 8fuu-zz (Kev.:s-tib) Pre ,tion are obsolete. DESIGN4YAD FACILITY TO DESTINATION STATE (IF REQUIRED) 10887.1894