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;please.print Of type. Form Approved OMB No.205D-0p39 <br /> UNIFORM HgtARt?bU5 1.Generator ID Number 2.Page 1 of 3.Emergency Response Plane 14.Manifest Tracking Number <br /> WAST5MANIFEST CAL000374268 2 012485 FLE <br /> 5.Gerr�aW$Name and Mailing Address 1 I 877577669 <br /> Generators Site Address(if different than mailing address), <br /> Dollar General #13593 Dollar General#13593 <br /> 2098018822 4232 E MAIN 4232 E MAIN <br /> Generators Phone: STOCKTON, CA 95215-6720 <br /> 6,Transporter 1 Company Name I STOCKTO CA 95215-6722 <br /> U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc I MNS000110924 <br /> 7.Transporter 2 Company Name - <br /> U.S.EPA ID Number <br /> csp-�CPI& u{ <br /> 8.Designated Facility Nam and Site Address Rho Chem, LLC us:EPA ID Number <br /> 425 Isis Avenue <br /> Inglewood, CA 90301 <br /> Fadlvs Phone: 3237766233 I'• CAD008364j'f 32 <br /> 9a. 9b•U.S.DOT Description(including Proper Shipping Name,Hazard Class ID Number; 1fl, 11,Total 12.Unit <br /> HM and Packing Group,(if anyContalnara)) 10, Type Quantity. 13.Waste Codes <br /> WtJVbl <br /> 0 X 'UN3266, Waste Corrosive Liquid, Basic, 1 CF 06&2 P <br /> ;i22 D002 <br /> o Inorganic,. N.O.S. (Sodium Hydroxide, <br /> Potassium Hydroxide) By PG II ERG#154 <br /> Z 2 <br /> 3. <br /> 4. <br /> I <br /> 1. 11 515(Sasac Liiquids, Inorganic - Loosepack) - <br /> r - Yf 1E:�li�rehY declare WW[nods 4thlkconsiqnmen6 holy-and acaraleh'd9sa ed'a6ove by the prnpershfppiig name.and-acre <br /> arxl.areinay ,pgd ww- <br /> r m i 0°rd�'�' aa�ordorg appfrcahle.krPemafanrCenl- -nnw gorertwnWw regulagorrs.9export*WWI and I am ary 111e.PrQn <br /> �• ._ Off" pr�tcardarin to 7ra.nrrtm-of l�e.atraGred£P.4 Cflrrsenl <br /> Kidea0ai;n.4A CR,2n?Via)(Il am a.large q-"9e k3r)or Ilam a Annan gurx*generawx)is We. <br /> Mash Day Yom <br /> _ - U 0111 24 1 201. <br /> i:•: ;�mpoRtfl.U,S. ❑Ex{w fram u. Purl of entr*wt <br /> Date leaving U.5.; <br /> - cig <br /> Month Day Yea i <br /> all 241.=^011 <br /> Month Day <br /> b - — - Type —— ❑Residue ❑Partial RojeCbon LJ Fu8 Rajecliof <br /> MarvfesE Rafererx a Number. <br /> U.S.EPA ID Number <br /> 7 Hfdflfr; Day Year <br /> Tqr fdua: ste.hea&nen►diapowal,and recydkg.aystams) 4 <br /> S, <br /> 3 4 <br /> - ashi16a ��8- <br />