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, lIIIfIIIIIiIli11�IIIIIIII�IIfiIlllfdlllllllilli111l11 <br /> Please pri nt or type.(Foran designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page i of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST t f_11 t7fts'10f�74�r,fk q �-�� 008680859 FLE <br /> I 5.Gar amWs Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Dollar General ##.13593 Dollar General#13593 <br /> I 2096011218618� 4232 E MAIN 4232 E MAIN <br /> Generalor'sPhone, 9TOCKTON. CA 95Pt5-97PP 1 RVir".i>;'rnt+r_ rca wC;011 - r <br /> 6.Transporter-bCompany Name It U S EPA ID Number <br /> f Stericvt~le Specialty Itifasi:A Solutions incl I trtn;>~r rnf<zs tr ay <br /> 7.Transpoder 2 Company Name U.S.EPA ID Number <br /> B,Designated Facility Name and SdeAddrass General Environmental Mgt$ LLG U.S.EPA ID Number <br /> ..l f <br /> 00 11855 White Rock Rood <br /> Rancho Cordova, CA 95742 <br /> � FaciltlPsPhone: 916351098171I f�rsnst�rnu���tt�� <br /> 9a. 9b,U.S.DOT Description(inducting Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12 Unit e <br /> HM and Packing Group(if any)) 13 Waste Codes <br /> No. Type Quantity Wt IVoI, <br /> 'a k 1 UN19512r1 Waste Aerosols, flammable 2. 11 ER130126 1 CF 00010 P 3311.' D0011 <br /> 2Non RCRA hazardous waste, liquid (Consumer i DF 00043 P 331 <br /> Products)y <br /> 4, <br /> 14,Special Handling Instructions and Additional Information 1.1 10541(AE1-4't'R l 0 2. 110524(NOn—RCRA Liquid Waste (CA Only) <br /> LQosepack) <br /> 15, GENER4TOR'WOFFEROR'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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAckwwte ftWA <br /> I certify that the waste minimization statement identified to 40 Cl 262 27(a)(if I am a farge quantity ge (b)(i small g*ylf'geqerator)Is true <br /> ire n Nama na Month ay Year <br /> e- clk 7/-,- 1 vial i r I Per, <br /> --i �16.IntemaJldnalShtpmenls <br /> ❑Import toU.S. ❑Export 4M S Portofentry/exlb <br /> Transporter slgnature(for exports only): Date teawno U.S.: <br /> 17.TransportarAeknowledgment of Receipt of Materials <br /> Fe Transporter 1 PrintedfTyped Name Signature on ay Year <br /> S{ri,stolaher Altpanza tr, prhs" <br /> Transporter 2 Pnntedfryped Name atuie- Month Day Year <br /> ra 1 <br /> 18 Discrepancy <br /> 18a,Discrepancy Indication Space [] Quantity ❑Type <br /> ❑Residue CI Partial Rejection ❑Full Re)ecibn <br /> Manifest Reference Number <br /> 18b.Altemate Facility(or Generator) U S.EPA ID Number <br /> � t <br /> U ' <br /> W `Facllitv's Phone' 1 <br /> LO lac,Signature ofAltemate Facility Generator) v'Aonth Day year <br /> z I I I <br /> 19.Hazardous Waste ReportManagement Method Codes(i,e.,codes for hazardous waste treatment,dis <br /> posal,and recycling systems)LU <br /> ) <br /> 0 1 -4 IG If I" 0-1'—`1 i st13 / �4 < <br /> 20.DosVated Faculty Owner or Operator:Certification of receipt of hpapfous materials oovered py the mapiliees(except as noted In Sefn 18a <br /> y <br /> 7111 <br /> d Name Sfgnatd ' th DayYear J <br /> L V <br /> BPA Folin 8700-22(Rev.3.05) Previous editions are obsolete, E �.�'' ESIGNATED FACILITY TO GE 7011 STATE(IF REQUIRE ) <br />