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EXHIBIT C: GENERATOR MANIFESTS SUBMITTED TO DTSC (CONT.) <br /> Please print or Pepe 11„1,1110 1,1111 Form Appmv& OMS No 2050-M.19 <br /> UNIFORM HAZARDOUS 1 Gencralbr ID Nunbx 2 pap T Of 3 6 fprkCy Rlnp—P— a,Wn m <br /> WASTE MANIFEST CALO00381582 1 8775772669 �M517 9 3 F L E <br /> 5 C.[ra.'r'BrdfS Name and Arming Address Oerwata's Srs!Adr}ess[rf ddrererd Vw7fI maAdg.d nm) <br /> Dollar Tree #3771 Dollar Tree#03771 <br /> 2094785825 7528 Pacific Ave 7528 Pacific Ave <br /> Lbr0rA*&pbwm Stockton, CA 95207-1929 Stockton, CA 95207•-1929 <br /> 6 TQreporurl ComWf kOft US EPA 0 rrumber -- <br /> Stericyvl a Specialty Waste Solutions Inc MNS0001le9r4 <br /> T TranwcrW 2 CarMn7 Name U S EPA 10 N=brr <br /> Worldwide Recovery Systems CAR0OO175422 <br /> d Oasgrtaled Faulity None and Site Ada= Yuma Yes, LLG US.EPA IU lytmber <br /> 2738 E. 13th Street S <br /> Yuma, AZ 85355 <br /> arayi F rsxle 9.'..86428938 AZ R6O®515924 <br /> 9a Z U 5(X]T DcRFj-.b a OnfLding Pruper Shpprg mama.Ks.'ard Claw.10 Nunbr, TO Corawws 17 Tata' 12 llrl-1 53 1YaSiC Cada <br /> H'3 and?x.- ,i;rwD Id aryl) .{u Type Oua" 1AAV <br /> t Non HGHq hazardous was e, 1Q1i1 onsuaer <br /> � i <br /> Q Products), -j <br /> M Non KLIRA fia2ardous waste, solid onsuser 3Z I <br /> Products), _. <br /> 3 <br /> I <br /> 14 ate KegulateO Liqui s ,✓. a e Regu a e. <br /> Solids) <br /> 15 GEHERAT0RjW0ffERC jCOTW"TIOH:I*Mr y 0CC49*ft Ca axwts&tnoDm*rndow fully dno eav mIy dc=bm am by ma pecow s*png nam,and a-e Tasgec;jw7u 5. <br /> marked and lab6ad]placardad and are in all respecm i�prdper upndldm inr Tampon xmrdirg b aplrable MWr6WrkWseW(bd7rral gvterawtal ragablKns if eepurl 5pwmern and :.m,r.Primiry <br /> F>xft..1 ren•.-ry 1hx the uarvats of this ccygrmer4[drddrm b9le temsM To atlatNd FPA Acknm .e4r*M of COMM <br /> I ow*M01 CK'"a nn-izirix stalameM OgntiCbd ina0 CFR 267 21(a)[if I am a large qla n )crib)(dl Into <br /> )ren worE Fan yTyped Nam* _ 1{l ro L' Yfar <br /> c <br /> fIV [� 3 2019 <br /> Iii InpCrcahunal b LJImW W U 5 ^ <br /> r i J Expon'ro:n V S PdR denhylrxd. <br /> ?I rrx*Poger spnaaue:for NT:grs ah} Dade ewng JS <br /> Ir 17LLj <br /> rrmrsporeerAtxn�.lcegrrcrrtaliecep[MlnxaaH <br /> Transpbrkr 1 ft4adRyaoa Ngnl@ Sgmtu a ?.kw Doy Ydar <br /> a Johnny Harper A 1 01 3 2-019 <br /> = 7r—r pwLe PnrAeNTlpgd Nae* Sigrtaluo Nlutlh <br /> Day Year <br /> r <br /> 19 Rsacpancy T � <br /> 1&7 bi9tl9)A�rcY trldicadon Spxe 1 (2i rtly L Tm Resdue U Peru R*,A. iFul rtejemcn <br /> lkirdcel R*mrgR dumper. <br /> 1 e AfternaseFinay(QC ) V$EPAIDrumbm <br /> J <br /> V <br /> rat. F3lAYS Prom <br /> W 16c 5ignaose otAlremase Fanmy[or Genudlrxl 1r nlh Oo1' 1'9ac <br /> a� <br /> 2 H f��.,�,,,,.19 Harardov5 Woolc Report 1 wepmarll Mogxd Cbdz[i■..[odea for tuzarftks vcsPo IrealiwL disposal.aro wydK9 synl <br /> LU 1 2 3 4 <br /> 20 DrrsgmW Fadiq Omar or[4eralbr C oawari of receipt G ilazwaaus rralariag wrered by be manrest CRxm%w rKWd in tWn ISa <br /> PmbArryped bbna SKPAre "AmSay T-, <br /> EPA Form 0700.22(Rev 12.17)Pre,na,s@McMore otsdlete. DESIGNATED FACILITY TO EPA's e-MAXIFEST SYSTLM <br /> A7M-PP 1?vA raI A47010i1 A g40O0P444 n4i 7aaqg7 M [Mai zi IQ cnai xi IQ <br /> May 23,2019 Pg. 11 <br />