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6'76967- S 4 <br /> 2407566-D01- <br /> Plcase.plirtortype.(Fonrtdtsignedfor use onetle{12•plth)tyPe+rriier) FoITRAppraved.0MBNO.2050-0039 <br /> U I NIFOR14 EfAZhRD0b$ I 1-(;Cnoaloo.1)j1sarkxr 2:Px�elOf 3.Elnc encyRCspn ePlane d.ltaalfeslTratkingltam6er ' <br /> VIASTEMANIFE4 CAL000391073 2 (877)577••2669 001297234 PSC <br /> 5_Geoclzlots Naw w l:A OgAddcss7 Gef"'Ors sac mdress(a adlerCnt Um plahpddress� <br /> CLC LO'T'S STORES CrG LOTS 44457 <br /> 300 PHILLIP R©,A171,;:DE&A ERARU._ 201 N.TRACY$LVE). <br /> CQLU ABU5;OH 43228(514)278-4614 TRACY,CA 95376 2908306312 <br /> ' G�rovrata�sPt�ax~ <br /> 6.Sr�ngcOrtts oaganYNarne ,. ir.5.£PAtOtrurnber - <br /> .21st Century Environmental Manasement of California,LP j CA110011210017 <br /> 7.7sasupcRer2 Name /' U.$,EPAIDiti nber <br /> 1}�lr � f~e� 'v`�e CS �Z <br /> 8.De9gnaled FaaUy Name and Sita Add= U.S.EPA 10 Number <br /> 21st Century Environmental Management of Nevada LLC <br /> 2095 Newrands Dr.East, <br /> Fernley NV 89408 (775)575-2760 NV139808$5339 <br /> FaWsPiwre: <br /> g�L 9b.US.DOT D=i06a(oxfu(f•,xjPronvr S6 i V Name.HaWCt,---,ID Minb[x 10.Cvrums 11,T014 12.1M( la.Waste Codes <br /> 33hi urdPadci�gC,rvaPC�a+rY)i r1v. Type O=Qy MllfoL <br /> 1.UN195a WASTE AEROSOLS 21 <br /> � 4 Qao: <br /> o X. OF 11 P <br /> } c <br /> 1 <br /> to 2,UN2014HYDROGENPEnoxIOF,AQUEOuSSOUITiOt�S i71JNOTLESS'THAN20%BUTNOT pawl T35 <br /> L, 710A£THAN 4 YSC HYi7iSOGEN PEROX4Bi (c5`l,HYpROGEFf PER07(I�E)S.t(Bj PGIE OF p <br /> t - <br /> 3.UN3M WASTE C4RRUSIYG l 1QF1f[},6ASIC,INORGANIC,It.O.S.(SQalUhl iYCRQXIp <br /> x POTASSIUWHYOROXIDU)8AGil <br /> t 131; S P <br /> 4.7JN1Yj3 WASTE FLAMMABLE LIQUiOS X.O.S.(KEROSENE,DIESEL)3 PC11 ` <br /> DO01 .()005 ', DD07 <br /> x 1 DF 1s F <br /> - 0010" -11002 '0005 <br /> f <br /> t 14, at lsuWcaorlsar,aAe6sDvnardamatiw, <br /> im - <br /> (1) £Rt�-02-BiiS{126}ELA6RDSCLS-02-AERd&OLS{$)SLPEROXIO£-02-ERG{1<0}BLPERD%Ir?E-A2-HYDROGEN PERax1pE{�BLCORJ;8ASrG42-ERC(15d)pLCaRrIIIASEG <br /> .02-BASIC CORROSWE UQUIDS(4)SLFLAMLlQ,U2-ERG(I28)FLAMMABLE LIQUW <br /> 1S. GEItI:RATORSlQSf[324R'SCERPfFiCATtt?N:IherehydedarClhattMewrtcrtsdlLismrsgmtwnlarehCryargtaccuraietydesaibedabavebyihcprapershippirog�mne.and aredt�svTwd.pacfagc.�f, <br /> marircd ardtaWedl&cxded, gvvamlerrtal regufa"i M tf oxpvrt stipaw and i an etre primary <br /> Elra+ata,J atii$yttial the erKilents of t3i:s�gmx�nl tad0m�t41hc tau of lf�c attad>ed EPAAckrwrdtttgrnrnt aF Cur>9cat. " <br /> locrfilylhatil�wase m�ar+vzalion A2Jemeetidco6f+edin�lOCfi22fi22f(tr�{d[a:is a large quarA�p gaserator(ar(bJ{4#2rna small4uanG[y gcactaiorj is lruc. - <br /> aors ypC4 Name wim Vay yew <br /> 5 1 31 16 <br /> i8.trdat>3tianal SSipertierdF J rpat to U S. Ejowt fiat U.S. Pod d afrylexd: <br /> Tra crss urc facxporisor!�: DataIeavimU.S <br /> w 1Z,Tsa4=peitaAriecigirl+lafRcc�lnftl�aizis <br /> ranspnta 1 H7 JcNtypCQ NarnC gC Marih ray ya <br /> Isidro Martinez ' 5 31 16 <br /> T Prtrtcd!JypCdN ue Atrth Day Yc;w <br /> k9—14 <br /> /4 <br /> - 16.DatrcpaltCy - ��--``�� �!----•1� <br /> tBaQisacparKyJndtiCivnSpate 11QvaaFtiy ❑Type 1JRtsidcr OPartiatRe}edion tJFWR*,15. <br /> Manifest Rdmnce Nurnbeu <br /> iPb,/BCrt icFasydytorGt�tClala) U.S.EPA1DNumW <br /> faa'tA spYana - <br /> 18c5gn2l0rc ofntlfilroleFadrty(brGe,>cra?vr} Mach Da" Year <br /> .d , <br /> z <br /> 19.tlaxardonsWaste l3eMManagar=tMclhodCodes p.c.,00desfor(r udousrraste(ieawcdsposaF'wdMeCA%ty w4) <br /> a 1. H040 2 H070 �� 14. H061 <br /> 2O.DosigfuIedFaaEiyO�vwnrDpaatnt:Calix ipso#rccclpiuFhazardovsmaleriaiscovcredLyOlemawestoxCCMas rVed Inrrnl8a <br /> J�lat Eypeddiome J Slgnatwe t apkfe [lay Year ' <br /> EPA form 87a22(Rev.3-0) PreviaasccWiansare2016 <br /> n�aVAAbsof n(ryI�CLc. " <br /> JUN 1 <br /> pi t f • 1 � i 1 <br />