Laserfiche WebLink
272023.18 <br /> Alease nntor 001938.552Puc'C.. 326167$-QQ1 <br /> p' Rype.Form dasigned far use on elite(12-pitch)type rile,.) ' Farm Approved.OM8 Nq.2050-0Q39 <br /> UNIWRM HAZARDOUS 1:Generator ID Number 2.Page 1 Of 3.Emergency Response ptrgne Marsifest Tacking Humber tf <br /> WASTE MANIFEST CAL00039'i073 y'. �877y 57T-zS69 DUB 938582 RSG <br /> 3.Generator s Nameand torp dress GenEralOi s Slle Address{ii different than ma trig address} <br /> 1310 LOTS STORES SIC=LOTS#4457 <br /> 3W PHILUP'R0,ATTN:DENA FERARU <br /> COL11JIMS S,OH 43.226(814)276-4614 2881 N.TRACY BLVD. <br /> Gerserago, 's Ahono: 1p TRACY,CA 95379 2096306312 <br /> . ranspo er yany ame <br /> STERICYCLE SPECIALTY WASTE SOL"ONS I G U.S.EPA ID Nwber MNS000110924 <br /> Y.TraaspO tar 2 Company m <br /> U.S.EPA ID Numbar <br /> ck <br /> ton aci5ly None and Site Address <br /> 21st Century Envlrclnmental Managament of Nevada LLC U•S.EPA IDNumbor <br /> 2095 Newlands Dr.East, NVDOBW95338 <br /> Fernley NV 69408 (775)575-2760 <br /> Facriify's Phone' - <br /> 4a. 9b.U.S.DOTi7escription(induding proper Stripping Name,Haiartd Class.l6 Number, ip.COntalners <br /> 11M and Paekidg Getup(if any)) 11.TOW 12,Unit f 3. Waste'Cades <br /> Na. Type QUanlly WC,ftli. <br /> 1.. UN1950 WASTE AER I SOLS 2,1 - <br /> X 1 331 [xrot <br /> - - - OF 3 P <br /> 2. --10 WASTE TOXIC,LIQUIDS,ORGAfl1C,R.O.S:(2,A-pj 6.1.PGII - <br /> )( - 331 0018 ••. <br /> OF - 25 <br /> 3 - <br /> A.. <br /> 14.Speciel iiantll ng In5lnlcl ons and Additional Inlormat on <br /> 08 LAEit LS-04.41116(126)BLAEAOW S-04-AEROSOLS j 9LTOX1C-03-ERG(M)SLTOXIC-03.TOXIC UgUIDS LOOSEPACK - - - <br /> 15. GENE11ATGRWFFER0R'S CERT1FICATJ0N; f hereby.declare tha the contentsofthis cansignnrent are f*and accuraloty described above by.Pw PmW shipping Dame;and are class48ed,paek�ed, <br /> marked and tabeladfpfarardad,and aro in afl resyeCis in proper OOndlf n for transport according to applicable in[ernationai and notional governmental regulations,if expert strlpmml and.I am Ilre Primary <br /> Exuoftor,1-14 ttlat the contents Of this constg4nenl eonfoml to the 11;,= lho attached EPAAcknowWgrpenf of Consent. <br /> l.cert fylhal the wte mfnimi2at 0n statanenl derildred in 4tl CFR ZS2,27(a){d f am a large quantity gen )a(b;{F i am a sural!quantity pan <br /> neralo fors nn y me a u ay ear <br /> 6 20 18 <br /> —�r 18.tniernalons[Shtprrlen Qlmpol£ioU-S. ❑1�,,,,rcrrrrU.S. Port ofentryko: ' <br /> Trans ftCrsi nature fore on Dateteavin U.S.: <br /> 17.Tran sporferAcl np�vindgmertt dt Receipt pi Materials <br /> Transporter [sdfTypad ame gnaure <br /> An ay o2r <br /> R Andy.Winkler 6 1 20 1 18 <br /> Trar,5por4er 2 PrintedlTyppedrName gn ore <br /> t � on ay ear <br /> 18-t}iscropancy- . - <br /> 1tia.Discrepancy Indication Spore t]uanfily .. Ty a <br /> i2esidue Q Partial Rejection Foil Ra cclion <br /> Manitest.Rererer"Number: <br /> Ift.Ailemete Facirity(oa Cenerator) U.S.EPA Iq Nurnber <br /> u FaciGl's-fi w. <br /> the.Signalure OTRbernale raoity(Or rata) MAh Day Year <br /> 19.Hazardous Waste Report Management Wthcd Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systemsl <br /> o is 2. 3. 4. <br /> H141 H141 <br /> 20:i signaled Facility-Owner or Opecalor.Carl3fcativn of(eceipt of hazardous materials evert d by the m_anNsSl.except as nO1ed in 1tar 18s <br /> PIIe (Typed Mame Signatrna <br /> t�, yLblAt <br /> EPA Form 8700 22(Rev.3-05) Previous editions are ob'snfote- . <br />