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<br /> Please print or type.(Form designed for use on elite 02 pitch}typewriter.) Form Approved.OMB No.2050 0039
<br /> UNIFORM HAZARDOUS 1.Generator ID Number 2 Page 1 of 3 Emergency Response Phone 4.Manifest Tracking Number
<br /> WASTE MANIFEST ICAL00037314176 f 18775772559 008,548287 F L E
<br /> 5.Garter lon Name and Mailing Address Ganerators&te Address(if different than mailing address)
<br /> t Dol,lav, seneral ##13592, Dollar Seneral##11592
<br /> 2098681320 31+0 W DR MARTIN LUTHER KING .IR 3110 W DR MARTIN LUTHER KING JR
<br /> Generalor's.Phone: -aTOCKTJN. CA 952..46. 1763 I STOCKJON, CA 919206-1763
<br /> 6.Transporter 1 Company Name �- US EPA ID Number
<br /> . StellirvCle Snerialty Taste Solutions Inc I MNS0001i@924
<br /> 7.Transporler2Company Name U.S EPA ID Number
<br /> 8,DesignatadFacility Name and Site Address Senov4al Environae tal Mgt, LLC U.S.EPA ID Number '
<br /> 11855 White Rock Rad
<br /> Rancho Cordova, CA 95742
<br /> Facilliv's Phone SJ635111I980 I CA1198(884183
<br /> ga. gb,U,S,DOT Description(including Propor Shipping Name,Hazard Class,ID Number, 10.Containers 11 Total 12 Unit 13,Waste Codes
<br /> I HM and packing Group(d any)) No Type Quantity Wt Nal.
<br /> I X JiN19501 Waste Aerosols, flammable 2. 11 ER1301216 1 CF, '00014 P 331 D00i
<br /> o
<br /> w X i-PU993, Waste Flammable liquids, n o.s. 1 CF 00008 P 331 D001
<br /> CD
<br /> (Alcohol), 31 PG Il� ERG#}R$
<br /> 'v r
<br /> X M32E61 Waste CorrDrsive Liquid, Basic, i CF 000.01 P 12p, POOR
<br /> ,Inorganic, N,0.9. '(Sodiva Hydroxide,
<br /> Pota.rivn Hydroxide}. a. PG 11. ERG#154
<br /> X i-IW077"1 Waste f:nvironmt-ntal?y hazardous 1 CF 0:0002 P #.til d009
<br /> subs rices talid, n.o.s. (Mercury, Broken
<br /> ♦»I f>nraar+prtt i i nhft 7'rthr,-). 9. PR T T T. ERG# 171
<br /> 14.Special Handling lnslmcuonsand Additional Inform Win 1. 110541(Aeraspls) 2.110518(FIAMmable Liquids - Laosspar-k} 3.
<br /> 110515(Vlasia Liquids, Inorganic - Loostepackl 4r 110544(MeeQury Containing Waste (BraPen
<br /> ,Fluorescent Lavp) )
<br /> a
<br /> a ,
<br /> 15, GEN ERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accutately described above by the proper shipping name,and are classed,packaged;
<br /> marked and labeledipiacarded,and are in all respects in proper condition for transport according to applicable intemahenaf and national governmental regulabons.If export shipment and Jam the Primary
<br /> Exporter,I certify that the contents of this consignment conform to the terns of the alfached EPAAcknovdedgment of Consent
<br /> 1 certify that the waste minimization statement Idenbiled In 40 CFR 262 27(a)(if I am a targe quanhtygenerator)or(ligif I arra small quantity generator)Is true
<br /> e toYsf011orors Pnnte Jar"n t��� I�tore // r � I Monm I ay Ir Year
<br /> F Yrr))((//,,((//e))�� (J/LJ/L ti"14 'r:l, 17-1017
<br /> ..t 16,International Shipments
<br /> z ❑Import to U S ❑Evart from U.S, •Port of enfrylexd
<br /> Transooderslgnalure(forexeede only)` Date leaving U S
<br /> w 17.TransporterAcknowledgmentofReceipt ofMaterials
<br /> 7ransponer 1 Prntedriypeo Name Signature Month Day Yw
<br /> Lsldv o Martinez 04 21 12017
<br /> Q Transporter Pnnledfryped Name signature Month Day Year
<br /> 18.Discrepancy
<br /> 189.DiscrepancyfndicaUon Space ❑ Quanh
<br /> ty ❑Type_ ❑Resdue ❑Partial Rejection ❑Full Releclrort
<br /> Manifest Reference Number,
<br /> i8b•Alternate Facility(or Generator) US EPA ID Number'
<br /> v
<br /> LL- I
<br /> u lee.Signature ofAllemate,Facility(or Generator) Month Day Year
<br /> 19.Hazardoul Wase Report Management Method Codes(19,codes for hazardous waste Ueatfnent,drspo9al,and recycling systems)
<br /> LU� ' �- - 1Q I I2 ' - l��l� 13 � I4 1��1
<br /> 20,Dgsfgna(efl#acibly Owner or Operator,Certification of receV of hazgdQus materials covered by,jie mamfed except as no)eb in Item 18a f E
<br /> * ' Prinle ped Name r s gnator
<br /> Mon Da Year
<br /> EPA Form 8700=22(Rev.3.05) Previous editions are obsolete. — DESIGNATEDFA%rrY TQ.G'�I'ERASOR STATE(IF REQEII)�F�}
<br /> 8701-22 t2v3 CAL 20372032 S41053278 4082' 6ti M PDO4 9D0 24117
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