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IIIIIIIIIIII�i <br /> F'fease pnrd or W.(Farm designed far use on QW(12'010))typevm'ier.f Fam Approved-OMB No,205M039 <br /> LWOR d HAZARDOUS 1 GWeMO r ID Number 2 Pape 1 of 3 Emergwsy Respome Ftiono a.ftn teat Traetwp 1lmMW <br /> WASTE MANIFEST CAL000374268 1 8775772669 I 011387079 F L E <br /> 5 Gerrarawer Mame and"ngAddress CNWZ I SW Address(a dilfbmt dun meting atld—j - <br /> Dollar General #13593 Dollar General*13593 <br /> 2098008wz 4x.2 C MAIN 4232 E MAIN <br /> Gninah3rsPhme. STOCKTON, Col 95el5-67e,2 STOCKTON, CA 95215-6722 <br /> 6 Tm-apww 1 Cor vxff Name U.S EPA IO NumW <br /> Stericycle Specialty haste Solutions Inc "NO <br /> 7 TMrapalrx 2 CanpWy Nara US EPA ID Nunba <br /> Worldwide Recovery Systems I CAR0001754Z2 <br /> 8 Devgnalaa Fadly Name and SAeAft= Yuma Yes, LLC U S EPA tD Numberr <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Fadly�sPtrone; A, o^ AZR 924 <br /> ga 9b U S DOT Desaip M(Wu ft P'ropor S1*VkV Name,Hamd Class„ID Nunber. 10.Corrairv+s 11 Toot 12 UN 13 YrSie Codas <br /> HM and Packing Qvw(d arq)) No TW CLarrRY wt:va <br /> 1 Non RCRA hazardous waste, liquid (Consumer 1 DF 90055 A " <br /> i <br /> Products), - <br /> ------- <br /> I. <br /> lu Z. <br /> ru <br /> 3 i <br /> 99 <br /> a I i <br /> s <br /> 11 Spe®I Hardang Enetru["and AddWcWW Ml A Sm 1.1105 4(Non-RCRA Liquid Waste (CA Only) - Lo o s epack) <br /> eUERTMAIM:t hereby OK*e thr,Ura contents of this tanafpnment am tiny ad aavrataly Onoted abase by to proper sNppi%name.and are deswfi4 packaged <br /> mmioed and rabeleNplacarded.2nd ars in d rr4mcls n prayer cw0loo tar Marrspaft acmrav b wpkaua komow*and rradorrat goverrerrstal regulations t*qw v*FnwA ad I am the Prfngry <br /> Eaocru,I cgoy owfhe met is of w c v*=ra dw tianm dtle aamcb d EPAAdmmv adgment ofCamerr <br /> I=*to fie wasps miNmizaban sfattetent idwrmd io 40 CFR 26227{a)(d I am a tV qua ft yianW2W or(b)f a syWl%W#tyywreratra)6 ins <br /> Moria saey rear <br /> 0,MV AN I t I 9� �� 8 <br /> 1 rtratiorrat <br /> tr�--t� <br /> F _., Impan la U$ L..�J Eiport S Par dawyw <br /> TrarspwW siw me(tor axpofls wK Daft teawi v U.5 __- _---- <br /> 17 TrsispaferAGutvdgmantotRea+adMaNrEais ,Cf <br /> Fw T-Wmlerl¢mped([ypw Manch j Day 1 r <br /> 2 T Ypad Naas! -. <br /> 1&3 '°u"a°So" U Quardiry L�Type U Rasisuo [.J Partial Rot. U Fatl Rejection <br /> xkrNFrst aera�en�Nuriha. <br /> 18b.Alsace FeaYy(or Gene{ata} U.S EPA ID Nwober <br /> J_ <br /> I <br /> Q FacigNs PtlOfre. Maarh t3ay Year <br /> W tS�SeJrW+ed/Nern7leFacrldY4atGoneraiar'! <br /> Q I i I <br /> 19 Hwafts Waste Report Manayament MOW Cddies 0 e,codes for hazardous weals keakrr m db aW,and mcydra systsne) <br /> UU 1 2 3. i <br /> 20 De*ywted FvcQy OWr W or QpeMW Certltcaaon at receipt dtrata dors mrMMaq aTRred by the frcRaiest er®pt as neem 78a <br /> NgMNM <br /> onth Day Year <br /> to-rr,g411) <br /> EPAForth8700-22(Rev.;F) RV'*5editionsareobsajete. DUSK;NATED£AgiITYTO UL5TINATI M 5iATF(F Rf`OMED) <br />