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40649-1$ 902005767P8C <br /> Pieasiont oe type-(Fam4es d for use on epte(12-pitch)typeilrrfter,) D Form Approved.OME No.205HO39 <br /> UNIFORM HA.ZAR l0US 1-Generator ID Number" 2.Pageof 1 3.Emergency Response Ptwne 4.iF+niFest Traekmg dumber ' <br /> WASTE MANIFEST i CAL000391073 tsrfl 7-2sss 002005767 PSC <br /> 5.GeneratoYs Name and MailargAddrass Generator's S'rle A,ddress(f Oererktthan making address) <br /> BIG LATS STARES � BIC LOTS 414457 - <br /> $00 PHIL)<.1P RD,ATTTI:GENA FERARU 2581 N_TRACY BLVD. <br /> COLUMBUS,OH 43228(614)278=4614 TRACY;CA 95V6 2038386312 <br /> t.,erryrata's Ptr�: <br /> ransparter I Cmparq -U.S.EPA ID Numt)er <br /> STERICYCLE SPECIALTY WASTE SOLUDONS(IAC ' MNSOOE}770924 <br /> 7Silef 2 U.S.EPA ID Number <br /> 8-.Dgignated Facilfy Dame and Site Address <br /> " _ U. -�!p tucsmbet <br /> 218t Century Environmental Marsagemew of Nevada LLC __. . f+VD980805M <br /> 2095 NeWlartds Dr.East, <br /> Femley NV 89408 -(775).575-27M <br /> Facditys Phone <br /> ga, 9b.U.S..DOT Description{including Proper Shipping Name,Hazard Class,ID Number, 1(LContainers 11.Tim i2.Unit <br /> HM and Packing Gras('d any)] 13: Waste Cedes <br /> Na Type 011titr VV,M, <br /> J. UN1791 WASTE HYPOCHLOWTE SOLUTIONS s PGII <br /> 122 D002 <br /> X 1 OF 5 P <br /> 2.. UNZiNO WAST€T07r1r,LIOLWS,ORGAM-C N.0 S.(2,4.0)6.1 PGII <br /> Uj <br /> 331 D016 <br /> X . - - 1 IIF' 54 P . <br /> 3: UN7943WASTE FLAMMABLE L1Qlfltz5,N.O.S.(KEROSENE,DIESEL)3 PGII <br /> 331 Dom 0005. <br /> X 2 OF 22B P <br /> Door twin- •t.1m5 <br /> 14.Special Handling ImhctimarldAddlbMal Information <br /> (1)WMGTBLEACH-04-ERG(164)ULEACH(2)8LT0 IC-03-ERG(963)BLTQ%IC-W! TOVCLIQUIDS LOOSEPACK(3)BLtl,4EdLt(top-Et1('e(120)FLAMMABLE LtOE1tDS <br /> 15. GENERATORVOFFERoR S CERTIFICATION: Ihereby declare that ffresontents Df lhiscons�gnment are fully and xgKafa descdbeda6ovebY ft prnpersfripping narrre,acrd areclasuliied,Raged, <br /> rrarimd'ar d labebdoaca4ed,and are in al m speefs in pWcandrb'on for tampon acaoram to apptitabte eat anat d n ffwm ulations.If <br /> reg expert shipment and.t am the Fhirrrdiy <br /> tcporEar,Icertifytt€atthE~cpn{en$QFltss fwnfarmkstherrrssofttreChedtPAACkna green Con <br /> i(y wash nirtim¢alion rd ilio ed in 4p CFR 267.27(a)Cd I am a Iarge pantity )a eb rf I a smallMr <br /> genoratar) true. <br /> 12 7$ <br /> ...r 1$;International Shipments _ _ <br /> r trnp6d to U-S. Export front U.S.' Part of erdrrle4 <br /> Trans rter ' ature fore on Dateieav' " .S <br />• �,.17.Tr�sp�erAduiovAed9n�ntofRaAeiptof-f�laeriats . . ' <br /> .rarlSpKl w 1 pospedayped Nam j n ear <br /> Va"t Johnsen <br /> 11 1 .12 1 18 <br /> T sporfer2 PrinMVyped Name S a. Day a. <br /> W Discrepancy <br /> 18a.Discrepancy Indication SpaceElquantity EA Type Residue � <br /> PaAial Rejection ❑ to fgjeciian <br /> Manifest Reference umber, <br /> I&Attemaie Fajbty(or Generator) U.S.EPA ID Nurnbu <br /> F s Phone: <br /> LU 18w8ignabureofAflemaleFacTitY(or 6enera6os) tulogtir Day Year <br /> Q <br /> Z - <br /> 19.Hazardpas.Wask Report WnagemeN j&thod Cordes{.e..,CWest(rhaxardous Wage treatrnem,disposal,and recgcti;rg systems) <br /> 3.. 2. . 3. 4, <br /> H070 H141 H141 <br /> 20.Designated Fac#itr Omoer or Operator Ceriifi Doi of receipt Of hazardous maWats'Covered by the man fort except as nqW in Item 16a <br /> Prieto yped Name Signature <br /> Me7ltfh' Day Year <br /> e. -- r <br /> EPR Form 8700-22(Rev.3-051 Previous eftom are obsolete. <br />