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2453 -1$ RECEIVED BY�CEHD (EF) on 8/9/2019 <br /> Please print or type,(F`uFm desigried tar use art elite 12- itch t 00191841 0PSG 5242714-�(} <br /> ( P } ypewriter. —( � Form Approved.OMB No.2050-0039 <br /> ?0(1 <br /> M HAZARDOUS nerator ID Number 2 Page 1 oI 3.Emergency Res <br /> E MANIFEST CAL000391tYT3 posse Phone d.bfaniFesf Tracking Number <br /> cs 577- �� 001918410 PSC <br /> a s Name and Mait ng AddrTSSTORES neralors iteAddrass(ifdifferentthanmairingaddress) <br /> ILLIP Ria,ATTN.GENA FERAF3UBIG LOTS#4457 <br /> MBUS,OH 43228(x514)278-4614 2681 N.TRACY BLVD' <br /> � nerators Phone. TRACY,CA 95375 2098306312 <br /> 6.Transpor-,1 Ompany Name <br /> STEHICYCLE SPECIALTY W STE SOLUTIONS INC U.S.EPA ID Plvmuer <br /> .Transporter 2 Co�U.. <br /> me iWN$000110924 <br /> U S.EPA iD%mbeerr <br /> �6' Designated Faviyand Site Address L1 J eta gg <br /> 21 st Century Environmental Management of Nevada LLC U.S.LPA ID tJumher <br /> 2095 Newlands Dr.East, NVD980895338 <br /> Fernley NV 83408 (775)575-2750 <br /> Fadlity'B Phone:. <br /> ga, °b.U.S.DOi Description(irlduding Proper Shippine Marne.i iazard Gass,0Number, <br /> Hm and Packing Group(if any)} 10.Containers 11,Total 12-Unit <br /> No. Type Qualtfiy YVtNot, 13, Waste Godes <br /> 1. <br /> ix UNi350 WASTE AEROSOLS 2.1 <br /> 331 Da41i (3 <br /> Q - 1 DF IF P i <br /> ir <br /> LU <br /> 2. UN3266 WASTE CORROSIVE LIQUID,LLj BASK,INORGANIC,N.O.S.(SOOPUrtP HYOROxFpE, <br /> u, x -POTASSIUM HYDROXIDE)a PGII 141 I U0EF2 {j <br /> 1 DF 13 <br /> "s. UN1993 WASTF FLAMMABLE LIQUIDS,N-O.S.(ICEEiOSENE,UI5EL)3 PG[I T <br /> i D0 <br /> x i 4F1 D001 - <br /> 12 P <br /> tJ007 .pole _) 1)036 <br /> 4, UN2916 WASTE TOXIC,LIQULDs,ORGANIC,N.O.S,(2,4-D)63fist <br /> x - 331 D01t3 <br /> i DF 61 P <br /> 14,Special HandRng instrudions and Additional Information <br /> (1)SLAEROSOLS-04-ERG(126)SLAEROSOLS-,94-AERMOLS(2)BLC DARBASe-04-pHN163)BLCORRBAStC•04_BASiC CORROSIVE LIQUIDS(3)BLFLANLIO.03•ERG(1213) <br /> FLAMMABLE LIQUIDS(4)BLTOXtC-03-ERG(153)13LTOXIC.03-TOXIC I j()IjIDS LOOSEPACK <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I Hereby declare the;the tents of this Cpnsignmenl are fully and aaci rataty desorbed above by the prgpe shipping name,and are Classified,packaged. <br /> marked and labOaWplacarded,and are in all respects in proper Gundifion for Iransport according to ipp4cabte intemaffonal and national gouemnwtai regulations.ffexpon shipment and I am the Primary <br /> Exporter,I Cerfffy fitat the contend of this conS*menl Conform to the terms of the attached EPAk,*-nowledgment of Consent. <br /> I certify that the waste m nimization stalomeni identified in 40 CFR 25227(a) it I am a large quantity generator (b)(dt am a small quantity generatorl is true- <br /> e talo' era's PnntedTr ame r <br /> on ay ear <br /> 7 23 18 <br /> nternational Shipn-ents <br /> F- ❑Import€o Li-S. ❑ExpoR frpm U.S- Pod CF entryJexit <br /> Trans ortersi nacre for ex rtsonl }, <br /> Datle <br /> LU 17_Transporter AeknoMedgrnentof Peccipt of Materials <br /> Trtnspo ter 1 PtinteW i yped Name ZU-k <br /> �I ay ear <br /> CL Darryl Johnson 7 23 18 <br /> u> <br /> Q Transpu ter 2 Printedl7y d ie of ay Year <br /> 19 Discrepancy <br /> 182.Discrepancy Indication Space ❑ CJuanti <br /> �` - Type ❑Residue ❑Padil RejF r�bn ❑Fuk Rejecibn <br /> tllanife t f2eterence Number: <br /> L;} 18b.Altema4eFasilily(or Generator) U.S.EPA 11)Number <br /> d <br /> roti 's Phone: <br /> a 18C.SignalureofAlfernaleFaolity;urGenerat71 , Month Day Year <br /> d <br /> Z <br /> 19 Pazardous Waske Repot Management Method CodeS(i.e.,Codes for hazardous waste t(eahnent,disposal,and recycling systems) <br /> 1 H141 4. <br /> } Fl141 H141 <br /> 20.Dv,sgnated Facility Ownaror Oper&r.CeMfication of receipt of halardausrmlerialsaweredby ft rnaaffestexceptasnDlek Item 18a . <br /> Printedll yped Name Sgnalure <br /> __ ._. Z, <br />