�. 00000 � = \ CO
<br /> Oo O N n
<br /> Z3 o (D
<br /> W 00 00 N N N
<br /> O (1 O_ CD O N
<br /> O � U-i — — O O
<br /> Q 0 � �1 6) 0 000 7
<br /> O r r– r– r–
<br /> rrrr -
<br /> MMMM (D Cl)
<br /> M = Ivao 0 °
<br /> csyF'e IFann designed far use ort oiite(12-pitch)typewriter.) N
<br /> 77!s
<br /> .Geftoaler ID Number ,,,i Form CD
<br /> Fn�� '�E'TM'6e^eYq ow!k.1-;
<br /> CAL000369845 ] 8775772Ea6q�e �
<br /> ra' Address c:eneral.xi 3n.Wnrrwe
<br /> jr 0)'0685454 LLE '� _ _ o
<br /> 99 Cents Only #177 99 Cents Onl�yp177
<br /> 951120 E. Hammer- Lane 1120 E. Haemer Lane (a7 ,(7 ,(7 NO
<br /> StCckton, CR 95 10amts FStockton. CR 95210 snMee us Eve ID rw.m,r N W N N Ill
<br /> Stericycle Specialty Taste Solutions Inc W 00 � W N 2
<br /> MNS000110924
<br /> .Transporter2 Comprany Name (9 O
<br /> US EPA 10 N =-
<br /> 3
<br /> ..1 ymrrp �i �i
<br /> 9rnry Na"'s�rrUr 8I�i8638z173
<br /> arx�rr�>Edand sill Add— General -nvironmen ag , usbEsrn,yu,,,r., N
<br /> 'ri CD
<br /> 11855 White Ruck Rvad
<br /> Rancho Cardova, CA 95742 3 r
<br /> Fanners pror e.916351 @980 CAD980884183 U)
<br /> ga St.D.S.DDT Desavlim(ini Proper Shjppop Name,Harard Cl-.ID Numyar. In.Conlamers ,1 Taal ,2 lhra
<br /> lila and PaMng C;7«w,p(�I anlgl No Tyre O-14 WI Ad +7 vraae Cegrc O
<br /> X UN1993, Waste, Flamlaable liar:ids, n-0.S- 1 BA 00002 P 331 D0011
<br /> a (Petroleum Distillates, Alcohol), 3. AG II, ' CD 00
<br /> ERG#139 j CD -
<br /> wX `(p+119`.,0, Waste Aerosols, [flammable, (each not 1 CF 00022 P 21 D001� p 0
<br /> exceeding I L capacity)) (Aerosols), c_1, - D
<br /> ERG*12E.
<br /> Q
<br /> X 'iM13077, Waste Environmentally hazardous i CF 00005 P 181 D6091 O
<br /> substances, solid, u.D.s. (Mercury), 9, PG
<br /> III ERG#17i
<br /> "Nam RCRA tazardous waste, liquid (Consriger i DF 0b075 P 331
<br /> La Product=), CS
<br /> I c
<br /> 145pea 4andyngmsbudionsandAddiomllydwmerion 1.PKG–DF_10199 (Flammable Liquids) 2.101998(Aerosols) 3. N
<br /> 1019930-11 Fluorescent Bulbs) 4.10199C1(CA State Regulated Liquids) (D
<br /> O_
<br /> 15. GENERATORWOFFEROR5 CERTIFICAnoR:firemhy declare that the contents ofthis oonsignmerdam fully and as tely desc ibed above by the proper slapping name,and are basge6.patlrao?- O
<br /> marked and Wineleftlacarded,and are in all respect in proper condition for transport according to applicable international and noncom)gwemmenlai negulatiorrs-tt e�od shq,n,e,N and l am tlr vm 0
<br /> Expcnter,!rsdify mar me xn,errt-1 11 consipnmenl conform to the terms of the attarhk EPA AckncMedgri of Consent.
<br /> I Gi lhatttre waste minim',myon slaterni identified in 40 CFR 262.27(a)(i(I a n a large quay iiy generator)or(h)(if I am a small quantity generalor)4s Ince. -
<br /> Generator'Jafterofs PrmtetlR
<br /> Ix CD
<br /> ypedlVame pm re On Behalf nt s Only
<br /> ZS. r ! L� T r. ) Z
<br /> ..a 16 Inlern ionai Shipments 3
<br /> z ❑inw l be U.S. ❑E,g1on from U.S. pod of entryleait: -
<br /> Tra sigrelore for ezporls onl : Dale kavinq NS..- _
<br /> !Y 17-TimasponerAck-i"edgmerrtN Reoeiptnr Materials
<br /> i nanspoder 1 Pdnted"yped Mame Ignature mT a, vexcn
<br /> n
<br /> O a�
<br /> z Trani r d yp ame Signature pay try,
<br /> ( Z
<br /> 18 Discrepancy
<br /> 18,Discrepancy Indication Space rrI [[ 11
<br /> Ouanlily LJ iYpc ❑Residue u Partial Rejeclipn
<br /> Manifest Reference NumbaC
<br /> 18h AIlernale Fariliry or Generator) U r EM o Q Clgs U.S.EPA ID Number
<br /> a IJewl 5 Dr- Egsf FP-rnik , IV (���/(� Q
<br /> LL Facili,'s Pho -Z 111*V 1 0
<br /> HBe S 911 D lernate acilily for GeneralnQ unlh Day Year
<br /> ig.Hazardous Waste Repon Management Methud Codes(i.e.,modes or hazardous waste trealment,disposal,and recycling systems)
<br /> LU I 2
<br /> (D
<br /> C)
<br /> 29.Deslgnared Facility Owneror pperalnr'Certification of receipt DI hazardous materials wvered by the manliest except as noted in Item 1Flp O
<br /> Printed.Ryped Ham¢ Signature Month Day Year O-
<br /> � Q
<br /> PA Fo m R7pp-22(Rev.d-U5)Previous editions are obsolete DESIGNATED FACILITY TO DESTINATION STATE(1F REQUIRE[
<br /> CD
<br /> CI o
<br /> 00 - Cn
<br /> O
<br /> W
<br /> .,- 00
<br /> CA
<br />
|