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RECEIVED BY SJCEFfD (EF) on 8/9/2019f <br /> NRO <br /> ` <br /> 215028-19 <br /> ���1 .. <br /> Please prird or f}�e. '"" """��1 f 1' OQ2$f31853PSG 3581143-001 <br /> '+ r�PgO�d.QMR No:24.j"039 <br /> lJh(iFORM HAZARDOUS T Generattu Ii7 Number #' 2.Page 1 of 3,Enreryency Respdn�e Phone 4 Manifest Tracking Number <br /> WASTE MANIFEST I CAL000391073 1 (877)577-25 9 002301 8.T73 P' Sc <br /> 5 GeneratorsSTmdh�alilryArdrYss <br /> BIG LOTS STG�llenlu�s:$de sVdifrWe than m_ail;ngaddress} <br /> ORES BIG LOTS*4457 <br /> 300 PHILLIP AD,ATTN.-DENA FERARU 2681 N.TRACY BLVD. � <br /> COLUM13US,OH 43228(614)27$-0514 TRACY,CA 95378 2098306312 <br /> Ger*ratar S Phdoe- <br /> fi.frnn5port�l')Cxl any Narrle U.S-EPA 0 Numbar <br /> STERICYCLE SPECIALTY WASTE SOLUTIONS INC MNS000110924 � <br /> ?.1 ra ss rl?r 2 tympany Name rr U.S.EPAID Nu ber <br /> 7. <br /> f/ ' `ter 1 <br /> R-Iles gr,;�ter1 Facilly Name and Site Atldrpss US,[PAID t+funft <br /> 21st Century EnvIronmen al Managamerit of Nevada LLC �� <br /> 2895 Nerrrtalnsfs'Dr.East, <br /> Fernley NV 89408 (775)575-2760 <br /> rruilfy'sPnG,ie tO,-Ily <br /> Via.U.$,i)OT Op-smpoon(inchideq Proper Shtong Uwe.hazard Class.ID Number- 10.Canta12:UnitHLA a adPacaysGGroff pftartyj} Nus Type Wl.lttul. 19.�Vtrsie Cnrles <br /> T. UN79 i Ya1AS fE fLA�NfEABLf LIQUIDS,FLO.S.(KEM%NE,DIESEL)3 PGII <br /> 0 <br /> X _.. 381 oaol Boos <br /> DF 11 P _ <br /> DW7 ow _p035 <br /> Z 2. <br /> - <br /> s- UH26101NASTETOXIC,LIQUIDS,ORGANIC,N.O.B.(2,4-0)6.1 PGII <br /> x 331 D016 <br /> i OF yg P <br /> 4, <br /> la Spralliandnglnsfr criplsarldAddltlora!Ir�xrrtalon <br /> (1)BLFLAML9171M-ERG(128)FLAMMABLE LKXX RL(3)BLTOXIC-W-ERG(163)TO=LIQUIDS LOOSEPACK <br /> .�.0 Of <br /> 15 GENERATOR'VOFFEROR'S CERTIFICATION:f hrJphy declare lhatlhe c*erds 01Ihis carlsignnl ark ulty and accLx*f.p dest rbed above Ery Ibe proper striptielg name,etrd a e c#auiFied.nncicaged, <br /> ma&ec and Wele[Uplacarled.and arr imas mspects in proper cersddion€or tt'alispo4 a=rding la ap lx 'te interna3inn Fad natiphargovernmergal regrTNiaras If export�hipmerd and 1 an W.Primary <br /> type r I certify that use eonter>€ nsigranenl conform la Dae terms of the a3arlaetl EPAAclmowle <br /> .eddy the;vaste m nrrn on slatefil idenldied in 49 CFR M-27(a)(d 1 am a large Glenn ivraio0 or( dl am' al!q <br /> Lknintity qaTralor true. <br /> C�erier 's evor PrioledlType( N1 N.Swalure Mnnrn <br /> 4 ' Day - Year <br /> - 29.1 -19 <br /> 1S,Inlematinnal Shipments �''''( <br /> F-- LI Impwt to US, ❑Fxparl from 11.5. Part of Or it <br /> Transporter sonalure(ftp exparls only): Dain teavfrg U$-: _ ---- <br /> � tT.T�tsnsp«,,erAr:kaoar!ertr�tenlaft�veaptofM�efiafs <br /> F:anrpottcr 1 PrinlaVyped Nrerse Sir .ePAarth Day Year <br /> . gFA 4 29 1 <br /> ;jj Frarspertn+2 Proed±TyV6d Name ere M anlh Day Year <br /> rc <br /> f$.fhsucpaocy , <br /> 1 ES,i.Disrrep-artry InUic�kan S@'tee L! Quanidy ❑Type ❑Rnsi[iue ❑PatCsal Hejeclaarr ❑FcrII Rejcxlian <br /> Maoifesl Fefererlce NeiAber: <br /> 18b.Allemae Fari€1y(or(3coerator} <br /> U. EPA ID Number <br /> U <br /> Faciatvs Pher' : .- - <br /> 1Ec.Sigial we*1Atemale t-writyjucienerator} hl3nth Day Year <br /> z <br /> 15 flacard3)Lr. VaSte RgKgt Marra PMr!1 MctltOd Cdt1N5(i.e,,.rpdeS for bNaFdous waste lreatmerit,d0posal,rsrd recyclnq systrms) <br /> � 1 1. <br /> H141 z. --H444H141 <br /> L:? 1E5ifa Y.I4d Fnd.ty Ornaer or Operat7r..Genf 4caorl at recei t p1 hazardous materta6 covered by the m ni e1s plyas nded in flem 1&s <br /> ' PrFclecf Nal c afar hiunlh Day Yera <br /> 6/ 111 1 I LEI fel 1,7 <br />