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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST GAt_000379505 2 8775%'726(- 011386222 FLE <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Smart ?• Final #403 Smart & Final#403 <br /> 2094643829 147 N. Wilson Way, 147 N. Wilson Wi=- <br /> Generator's Phone: Stockton. CA 95205 Stockton, CA 95205 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 5ter-icvcie Specialty Waste Solution=_ Irtc tai 60001 1 092= <br /> 7.Trans er 2 Company Name , U.6.EPAID Number <br /> r <br /> 8.Designate acility ame and Site Address alSt Century EMN. LILL, U.S.EPA ID Number <br /> 2095 Newlands Dr, E.gst <br /> Fernley, NV 89408 <br /> Facility's Phone: 7 7 557 527 60 NV09&3-=53=8 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM <br /> and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> Xr-TUN1951101. Waste Aerosols. [flammable. each not 1 'F 00009 F <br /> 214 0011 <br /> oexceed Ino 1 L_ cauaci.tli) 3 2. 1. ERG#1c'E <br /> z h Waste Flammable liquids. n.c. s.Uj <br /> tEthanal.. lsoor00%=] AlcoholI. 3. PG 11. ERG# <br /> 128 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information , 1012292(Ae r 0 s o 1 G. Flammable) L. 101300(F 1 as m ab l e Liquids) <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental gu <br /> lations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(i a a small qua g ra )is true. <br /> Gener tor's/Offeroes Printedffyped Name bignature Un e rt & Finalon ay Year <br /> 1,13 05 P019 <br /> 16.International Shipments <br /> F- ❑Import to U.S. Export from U.S. Port of entry/exit: <br /> Z Transporter signature for exports only): Date leayoing U. <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter Pdnted/Typed Name natu Month Day Year <br /> ao Anthonv Mack 103 -05r �2019 <br /> Q=drryped Name ` Signature Month Day Year <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial RejectionEl j <br /> Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> Q <br /> �- <br /> Facility's Phone: <br /> LO 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C tt 1. � q 2. 3. 4. <br /> ki LA I <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Uwe A Sign!% Month Da Y <br /> i <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. '--- DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIR ) <br /> 8700-2212V3 CAL.20080121 S40020778 041339530 M PDO30519 SD030519 <br />