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Form Please print or type.(Form designed for use on elite(12-pitch)typewriter) F o Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000374268 11 18775772669 010790394 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing ad(!r-ss) Dollar General #13593 Dollar General#13593 2098008822 4232 E MAIN 4232 E MAIN Generator's Phone: STOCKTON. CA 95215-6722 STOCKTON. CA 95215-6722 6.Transporter 1 Company Name U.S EPA ID Number Steric cle Specialty Waste Solutions Inc MNS000110924 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address 21st Ce nt ury EMN,' LLC U.S EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 Facility's Phone: 7755752760 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. og X 1•UN1950, Waste Aerosols, flammable 2. 1, ERG#126 1 CF 00013 P 331 D001 0 M 2. LU c7 3 4. t r 14.Special Handling Instructions and Additional Information i. 110541 (Aerosols) 15 GENERATOR'SIOFFEROR'5 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 EPA Acknowledgment 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)(if I am a small quangty generator)is true. enerato ntedlTyped ame Signature on ay Year VW, 1 I 119111 P1 I P011 =4 16.International Shipments 1-- ❑Import to U.S. ❑Export from U.S Port of entry/exit: Transporter signature(for exports only): Date Ieavinq U.S.: rY 17.Transporter Acknowledgment of Receipt of Materials UJ Transporter 1 PrintedlTyped Name SignatureMonth Uay Year '1-, co T� __ M.-. W t 1 A 7.� -Year Transporter Print yped Si Mon ear .. 18 Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S,EPA ID Number J U LL Facility's Phone: Lu 182.Signature o Alternate Facility(or Generator) Month Day Year Z 55 19.Hazardous Wasie Report Management Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) LLJ G 1 914 + 1' I3 1.4. 20 Designated Facility Owner o jOperator:Certification of receipt of hazardous materials coveW by the manifest except as noted in Item 1 fa n Printed/Typed Name � [ Day Year kam�8 I Signature Mo I 1 1h 111 J/ 4 EPA Form 8700-22(Rev.3-05) Previous ns are obsolete. 10 D ITY TO DESTINATION STATE(IF REQUIRED)