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002002324PSC 335=1-001 <br /> 'lease print or lype.(Torun designed for use on else(I Zpitch}:typewriter} Form ApprnVed:OMB Edi.2N5D lJt)39 <br /> UNIFORM KWARDOUS" 1:Generator M Plumber 2.Page 1 of -3.Emergency Responae'Phone a.Manifest Tracking Number�y r� <br /> WASTE MANIFEST CAL060391014 2 (EIM 57`7-2659. 002002324"RSC <br /> 5.Generator's Name and Mailing Address Generators Site P,ddrgss(if ifierent Than mailing adress}, <br /> Old LOTS STORES BIG LOT'S#4106- <br /> 300 PHILLIP SO,ATTN:t)ElNA FERARIJ 380 S CHEROKEE LANE <br /> COLUMBUS,OH 43228(614)278-2708 LOBI,CA 95240 2033686S59 - <br /> GeneraWs Phone:'- <br /> 6 <br /> hone:."&,-TranWrwl Company N2rrte U.S.EPA ID Number <br /> STERICYCLE SPECIALTY WASTE.SOLUTION_S_-INC ItNMSOQ@#19924 <br /> 7.Transporter 2,Gompany Name U.-S.EPAID Nunter <br /> 8.Designated Facility Name and She Address U.S.FPA ILt Number <br /> 21st Century Environmental Managerrtem of Nevada LLC NVO9808953W <br /> 2055 kowlan>ds Dr.Last, <br /> Fernley NV:894M (775).575=2760 . <br /> FacifiVs Phone: <br /> 9a: -9b.U.S.DOT Description Wuding Proper Shipping Na*,Hazard Class,10 Number,- 10.Containers f1,TOO 12:Unit 13. .Waste Codes <br /> Hluf and:Paeking-GrouA(d any)) No. Type O uantilr M.1V <br /> 1" UN1*0 WASTE AEROSOLS 2.1 j <br /> � <br /> z 2. ON2810 WASTE TOXIC,UOUIOS,ORGANC,N_O.S.(2,4-D)5.1 PGtI j 0016 ` <br /> LU 331 j <br /> X 1 DF 32. P — <br /> 3. UN3266 WASTE CORROSIVE UWD,BRSIC,INORGANC,N.U_S_(SODIUM HYDROXIDE; :141 [ DIM <br /> POTASSIUM HYDROXIDE),$PGH <br /> x .. - - - 1 DF. g P - f.-..... <br /> j c <br /> 4" UM1791 WASTE ttYPOCHLORITE SOLUTIONS a PGO 1 <br /> x 1 DF - 10 P <br /> - 14.Special Handling instructions and"Additiornat infnrrnation <br /> (1)SLAEROSOLS-04-ERCA126)BLAEROSOLS-04-AEROSOLS(2)13LTOXIC-03-ERG(153)BLTOXIC-03-TOXIC LIOUIDS LOOSEPACK(3)BLfiARRBASiC- 4•ERGd154)SLCORRBASIC41 <br /> BASIC CORROSIVE LIQUIDS(4)WMGTOLEACH-04-ERG(194)BLEACH <br /> 15. GENERATEIitVOFFERORV CERTIFICATION:I hetebp dec w that tate co[Nents of this consignment am ft*and accurately descnbed.above by the proper shipping Brame,and arecbsslfed,packager!.- <br /> rnwked and labei8dlplacafded,and ate in all respects in proper rondft for transport axording to appltcatlte international aW national goY_emmental ragulatians-If export shipment nod 1 atrtheT'rimary <br /> Fxporter,I certify that the contents of this canWmeantconform to.the larms of the aOached EPA AdmowledgmeM of CorrsenL <br /> I certify that the waste minimizatibKsfatarnent identified_in 44 CFR 26227(a)-(if I am a 1vgC gener tbj{ill wI quantity generator)is true., <br /> A stt ay eGena[arse ar <br /> t �1 \'C t �^ 10 16 18 <br /> 1tr.trdernation I Shipments �I - <br /> t 1 Impart to U-S fran U.S: Pcsd at <br /> Transporter signature for ex Gal : to Lavin U,S.; <br /> 17.1 ramporwAcknowledgmeni of Receipt of MahNiak <br /> t� Transporter 1 Pnntedlfyped Name MWfh pay ear <br /> aaa- Andy Winkler 110 16 I y8 <br /> 4 Transporter 2 PaoledfTyped Name t1 Signature y. "Year <br /> 18.Discrdpanty <br /> 18a.Discmpanrcy Indication Space ❑ Quantity ❑Type ❑Residua_ �,Parlial Rejection - <br /> . Qfal kejecbon' <br /> Maeksl Reference Hiner:- <br /> 1$b.Allemate Facikty(or Generalor) U.S.EPA ID Number <br /> u <br /> ►�� Facili s Phone: <br /> Lu 18c.*nature of Wtemate Faolity(or Gerterd%i month. -Day Yeas <br /> 19,Hazardous Waste Report Managernent Wthod Codes(i.e..codes for hazardous w4-A treatment,disposai,antl recycling systems) <br /> d 1. " 2. 3. <br /> H141 H 141 I 'F .f l Hfl7t1 <br /> 20-Designated facility Owner or Operafor,Certification Of race pt of hazardous materials covered by the manifest exce noted in Ire_m 18y <br /> Pr n�dlTyped 5ignaluts Month Da Yea <br /> EPA Form 8740-22(Rev.3ZI Previous editions are obsolde, '. <br />