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EXHIBIT C: GENERATOR MANIFESTS SUBMITTED TO DTSC (CONT.) <br /> ?ease pmt or ryx 10.■®1111,O®lll" Farm Approvod.OMB No 26WMM <br /> UNISORM HAZAIMU5 I 1 Gwerabu 1D Nu'Mer 2.Page i of 3 Ern"rcy Response Pndne A mamas um Number <br /> WASTE MANIFEST CALOIZ1@381582 1 rY 8_�77J57726 9r 012951792 F L E <br /> 5 Gere aWo;Norm aid r lalhrg Address UIMOrOws See AOdrdss(if Oftnent iflan mailrg 2d1r95s) <br /> Dollar Tree #3771 Dollar Tree##03771 <br /> 2094736825 7528 pacific Ave 7528 Pacific Ave <br /> GrmoraWs Phare 95207— 29 Stackt On CA 9x5207-1929 <br /> 6 Tra gpwher:Caep7rry Hare <br /> US EPAID ffunrber <br /> steric ie Saecialtv Waste solutions Inc MNS000110924 <br /> 1 Trarssponer 2 company Name US EPv+10 Nuneor <br /> S Des r aaed FacSry ria nc a e s m Ad res 21st Century EMN, LLC US EPAFDNumbar <br /> 2095 Newlands Dr. East S <br /> Fernley, NV 89403 <br /> F.aW,Phone 7755752760 N'JIl980895336 <br /> ga 9G U 3 DOTDesaption(aduding PrmwSHPOTg Name,Hazar[r crass.ID Number 10 CD%iners <br /> Hp and Pxwrg(jvup[dart]) No TYPe 11 TOM <br /> 1'2 Nd <br /> Un �:•.4YaGfe Godes <br /> OC <br /> 1UN19W, Waste eroso s= asoma a 2-. , <br /> O r <br /> X 2 UN1993, Waste Flammable liquids, n.o.s. 1 Cf' 9 P 21 <br /> iAretone, Methyl Ethyl Ketnne), 3-, PG II, ; <br /> ERG#128 <br /> 3 ! <br /> 4 <br /> T-- <br /> 14 Spdal 1'and1m3 rrkstruWns wd Addwiall*rRlatim 1. lei!@643[Rerosol s) 2.1@-@850(F l an ma h l e Liquids) <br /> 15 GENERATOR'SiQFFERpR'S GERT&ICATION:r he"deGae to theoontens of;Iia mnstnmet>sam fully and aavrasely de5cabcd abase by the pupgr ShpPmg name,and are daaairnd.yadraped. <br /> nw.ud and Iabeled+olac rood No are n a7 raspeus in Mw mfdtw fwtraospoRacwTdirg m apPlirable'nle n rgfand rutionai gevemmantal mgura6orc pn <br /> doxport shwdaw;am me P*wy <br /> E xpbrier•r oorty bpi the comms of this mrim9nment cerjVm to sle tempt of to abirhed EPAAdvu'.iedgmCrn of comert <br /> tdrery!hat llw waste minilrMadn s@alemwt idwtilied a 40 CFR 26227(a)fel am a Or"quarky genaranrl or{bf[ifI am a sxrreu%Wb[y gmerAwj a!rue <br /> O!lersds Pn*iTyped Namd _ <br /> .3y S � MrnR1 Oay Year <br /> _j 1e Imenkbdnal Shipmens W - @ 31 2161 <br /> F 1....1 hwla u s EJEiw f . e Po*t bf eetiynw <br /> = Tumpor,br S;nWue Ifv"pwM only} Dale leaving U S <br /> L <br /> 17 T*aRWQW kkvhtedjment of Rema tof klmariab <br /> Tr POW 1 PnnlodTyped Name Signature fdprm Day Year <br /> IL Johnn Har er 04 312@1 <br /> rsnsportcr 2 Pnn19C 4yped Name Signae.re N1en11+ <br /> a' Day year <br /> ,8 OISpCpalcy <br /> 183 Dweparcy Irulcow$daps ]UWrd�y Type Reyprc Lf Paft ReyKb- ,Ful Repc-cr <br /> 19h A*rnate Fwaty(or rxrera07ry Manifest RPsr, owe Nlxnber <br /> U.S FPAIO NIpnbpl <br /> J <br /> U <br /> � FaC11ty5 PRor1E <br /> C) 1HC$rgrtah Vof AlLemaie Fauhty(w Gmruatml M.Xith Day Y,)ar <br /> a <br /> z <br /> (0 1S Ha rdous 1'1a81e RopnrlManagement MOM Codes ii e.oWn for pazwdaus wasbuIMOOffit d'apasai.and rerydirg symbms) <br /> CA 1 2 3 A <br /> 20 3agnakd Facrity pwner or Ope*N C-w1i L40nof recep(brhararddi¢materoo ovored byre manliest etrceptas nobw in*m iso <br /> PrintenOwW Name srgrianire %Lrdh 0ay Yes <br /> E>AForm87W22�Rcw.12.17)Previous editions areobso*Le- DBIGNATED FACILITY TO EPR' a-iV'i IF ST SYSTEM <br /> 09flA nn �n_.-•r rn. neY,s:.�n ..,ww.tinx�.i. n..�..���� .. <br /> May 23,2019 pg. 10 <br />