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PlaiBe print or type.(Form designed for use on elite(12-pitch writer. 11MUNION )typewriter.) Form Approved.OMB No.2050-0039 UNFORAf:HAZARDOUS 1.Generator ID Number 2 Page 1 of 3.E Res Phone 4.Manifest Tracking Number WASTE MANIFEST CALO@e371993 I1 �"�� 010177314 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if'different mailin�address) Dollar General #13357 Dollar- I,enerral#13357 2092531664 1201 WEST MAIN STREET 1201 WEST MAIN STREET GiorreraWs.Phone: RIPON, CA 95366-3027 R I PON, CA 95366-3027 transporter 1 ComF7aq Name U.S.EPA ID Number Sterid cle Specialty Waste Solutions Inc MNS000110924 7.Transporter 2 company Name U.S.EPA ID Number B. Designated FaciGiyName and Site Address General Environmental Mgt, CLC U.S.EPA ID Number 11855 White Rock Road Rancho Cordova, CA 95742 Facili Phone; 9163510980 I CAD980884183 ga, 9b.U-S.DOT De&eripliom(including Proper Shipping Name,Hazard Class,ID Number, 10.Costa hers 11.Total 12.Unit HM and PackIry&txip I f any)) 13.Waste Codes No. Type Quantity Wt.Nol. '. Non RCRA hazardous waste, liquid (Consumer 1 DF 00106 P 33 Products), 2'•Mori RCRA hazardous waste, solid (Consulter i DF 00094 P 331 Products), 4. 14.5peaafHandling Instructions and Additional Information 1, 110524(Non-RCRA Liquid Waste (CA Only) - Loosepaek) 2. 11 29(Non•-RCRA Solid .Waste (CA Only) - Loosepack) 15. GENERATOR'SIOFFEROR'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 EPAAcknowledgment of Consent. I cedify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if l am a small quantity generator)is true mora s nt yped Name Signature Month Day Year 14- 20. 7 rj16 International Shipments t ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z signature(for exports only): Date leaving U.S.. 17.Transporter Acknowledgment of Receipt of Materials ransporter 1 PrintedlTyped NameSignaymonth Day ear Jeff Hamilton � 11 14 20,7 Q Transporter 2 Pmntedrtypod Name Sf 9na Month Day Ycar 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 186.Alternate Facility(or Generator) U.S EPA ID Number J U Q LL Facility's Phone: I Be.Signature of Alternate Facility(or Generator) tLi Month Day Year Z I W 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling e7s:ems) p t. fL i 2. i� 3. 4- 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a yped Name Signature Month Day Year Vei/h,ell r ,ez I 111 12 1 1'7 EPA Form 870 -22 Fev 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) nfl� 1 1._. _ .. ,� t ^r;i ._,rnr?�?�;�?�� ••^L- �r:C n�,.s�ar,17i —.A fii _, ..1? .,. ,.