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c%24y 14-1 to— 11 S11112 1151 a WN216 1I 1110101 1e <br /> Plea§e print a type,(Form designed for we On elite 12 itch 001913343PSC Ll f Vim- 3236706-001 <br /> ( P )ryPLwrriler.) Folin Apll/owed.OMB No.2050-0039 <br /> t1F11FOR61 tiAiJllzla(}US 1 CreneralCrfO Number 2 Page 1 of 3 Emergency Response phone 4.miini(e>yy Tracking Number <br /> WASTE tAAlrIFEST CAL000391168 2 (sin) 577-2sBg 001913343 PSC <br /> 5 actors Name and Mating Address Aerators Ste cess d'd <br /> 810 LOTS STORES (i dfers<nl than marNri address, <br /> 300 P"ILL1P RD,ATTN:DEKA FERARU BIG LOTS mw <br /> COLUMBUS,01143228(614)278-2708 2'�COUNTRY CLUB DRIVE <br /> Generators per, STOCKTON,CA 95204 2099410726 <br /> 6- eansporler Pwy Ram <br /> t!.S.EPA ID Nwatw <br /> S-TERICYCLE SPECIALTY WASTE SOLUTIONS(NC MNS000110924 <br /> 7.TQTbpU1Vrd Canpartlr Nana � » <br /> "A" /J ��/���! U S EPA Neuter <br /> /Wgw dvQry 4 �y►� <br /> 8.t]esipnated Faa6ryr and-94-e Address <br /> 21st Century Environmental Management of Nevada LLC us EFA-b mtier <br /> 20955 Newlands or,East, NVD980im338 <br /> Fernley NV 89406 (775)575-2760 <br /> Fa6M(s Phone, <br /> ga. 9b U.S OOT De=dP6on(11c106119 Proper Shooing Name Hazard Class.ID Nurrbt r <br /> 10 Contarrers 'otal 12 Unit <br /> it <br /> HM a1d Padang Group(i(aq)) Ho We Quanliiy Nl!rVol 13 W ,te Cedes <br /> 1 UN7950 WASTE AEROSOLS 2.1 <br /> DC <br /> QX 1 OF 9 P 331 0001 <br /> wR' 2 e11993 WASTE FLAMMABLE LIQUIDS,N.O.S.(KEROSENE DIESEL)3 PG! <br /> x 331 0001 Coos <br /> 1 OF 63 P <br /> D007 0011) 0035 <br /> 3. UN2$10 WASTE TOXIC,IJQUIOS,ORGANIC,N.O S.(2,4-0)6.1 PGIi <br /> x 33, D016 <br /> 1 DF 63 p . <br /> 4. tJK3286 WASTE CORROSM LIQUID,BASIC,fl40RGANIC,N.O.S,MMUM HYDROXIDE <br /> POTASSIUM HYDROXIDE)g PWO lel 0001 <br /> x 1 OF 14 P l <br /> 4.Special Pad"Instructions and Addbonal Ihhumalun <br /> (1)IIU EROSOLS-04-ERG(126)BLAEROSOLS•07-AEROSOLS 121 BLFLAMUG-p3-ERG(i2%FLAMMABLE LIQtADS(3)BLTOXIC-e3-ERG(1531 OL-TOXIC-03•TOXIC LIQUIDS LOOSEPACK <br /> (4)61-CORRBASIC-04•ERG(154)BLCORR5A3*N•BASIC CORROSIVE LIQUIDS <br /> 15 GENERATORWOFFTROWS CEICIVICATION: I hereby declare Matt the contents of this consignment are fultr and accurately described above by the proper shipping name and are dassfrled,packaged <br /> marked and iabeb4lacarded,and are in a1 respel%an proper cw6t1on for transport a000rding io applicable international and nAonai governmental regulations If export shipment ar d t am the Pamay <br /> Exporter,I Certify that the contents Of MIS consignment contormm the terms of the alfwtwl EPAAcknawledryrent of Consent <br /> Icer*ltl2t the waste mfrnraahm statement&nlft in 40 CFR 262,27(a)I'f I am a iargequa My generalar)or(b)(d I am a small quanlity generator)a true <br /> pf ame na re ar ea<� 7 23 18 <br /> 16.k1! Shipments <br /> ❑Import b U S ❑Export from U.S Port of entryrexrt _ <br /> Trans rBr ' nature(bre rts on . Dale!e3M U.S <br /> 1W 17 Transporter Agrro*dpw of Rece0 of Malen* <br /> jx ravp"r t rel yped are ature <br /> N Andy Winkler z 23 1 18 <br /> a TranspOrter2 Pnn yped Name rsignature Month Cay YeaOr <br /> 18.Oisaepancy <br /> t80.Disemparcy tndcalion Space ❑ Oantity <br /> Tlpe ❑Residue ❑Partial Re1erbd1 ❑Ful'F.elec4on <br /> Manifest Reference Number <br /> 1$b Aftemate Faclily(a Generafor} US EPA LO Number <br /> V <br /> Faci 's Phone, <br /> 1a I&Signature of Ailemale FaCtily(or wgoe) montw <br /> Q flat Yew <br /> z <br /> 19 Hazardous Ullaste Rettmt Management Method Codes(.e.,codes for hazardous waste treabnent,di%wsat.and reryrlrrg systems) A� <br /> t] 1 2 3. Tff g <br /> H141 H141 H141 <br /> 20 D"naled FacAly tamer orDparalar Cedi Mioo of recelpl of hazardOUS maWk is Covered by the rnanifeSl except as noted m Item 19a <br /> t7ICClfypedName�^,, SrgrrabrR W"! Day Year <br /> EPA FoM 8740.22(Rev.3-061 Previous editions are obsolete <br />