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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 t.Der erata 1D Number 2.Page 1 of 3.Emergency Response Phone 4 Manifest racking Number <br /> WASTE MANIFEST CALW�0379505 i 877577 669 012120094 FI_E <br /> 5. nerator's Name and flailing Address Generators Site Address(if cit rent than mai ting addre$s} <br /> Smart & Final #403 Smart & Final#t;403 <br /> 2094643829 147 N. Wilson Way 147 N. Wilson Way <br /> GeneraforsPhone; Stockton, CA 95205 Stockton CA 95205 <br /> ti ranspoater tpanry ame U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS6061101924 <br /> 7. ransporter 2 Gompany€4arie U,B:EPA ID Number <br /> Worldwide Recovery Systems CAR000175422 <br /> B:Designated Facvlityerne and She Address Yuma Yes, LLC U.S'.EPAID Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Facto s Phone:9286428938 AZ R0005 <br /> ga 9b.U.S:DOT Description(inctuclin j Proper St1iPp ng Nsme,Hazard Class,ID kimber, 10.Containers 11 Total 12,Unit 13,Waste Codes <br /> HIM and Packing Group(if anyj, Nos Type Quantity Wt PVttL <br /> 'Non RCRA hazardous waste, liquid (Consimmer 1 DF 1311069 P 331 <br /> Q Products)e <br /> z 2. <br /> w <br /> ca <br /> a. <br /> 4t5: ! <br /> 14.special Handthl;Instruct rms and Additional Information 1. 101320(rS.t at e Regulated Liquids —CA) <br /> 15. GENERATOR'SIOFFEROR`S CERTIFICATION:t hereby declare that the contents of this consignmentam bly and accuralely described above by the proper stripping name,and are classified,packaged; <br /> marked and labciadlplacarded,and are in all respects InpWer condition for transport aeconiirai to applimble international and national governmental regulations.h export shipment and 1 am the Primary <br /> Exporter:I certify that the contents of this consignment conform to the terms of the attached EPAAckrvA iedgmerit of Consent. <br /> I certify thatthe waste minimization statement identified In 40 GFR 282.27(a)Cd I am atarge Quantity generator!or(6)(if I am a small quantity generator)is true. <br /> Generator'slCiffis s Prinledirryped Name gni ure Month Day ear <br /> al of Smart & Final <br /> �►'f1�c.'?�+f 1� 02 �0i <br /> _j 16,international Stganenf5 <br /> import to U:S: ❑Export from U.S. Port of entr exit: <br /> T ra rax on:': Date leaven U.S.. <br /> ICK 17 TransporlarAdTiowliedgment of Receipt of Materials... . <br /> Transporter 1 PrintedMyped Na€argna t ay Year <br /> a0. Jeff Hamilton � 10 08 201 <br /> 0 <br /> z Trr2VtedrypedNta tw monin Day year <br /> 18.Discrepancy <br /> iaa;Discrepancytndication Srlac a { {ty ❑Type ❑Residue ❑Pantie Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b,Alternate Fadity(or Generator) U.S.EPA ID Number <br /> �- Faclltt's Phone: <br /> W t Be.Signature of Alternate Facility tor Generator} Month Day Year <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling syst�sJ <br /> 1 <br /> 4,441 U)I I _T <br /> 20.Dena fllty Owner or Operator.Cortil ersof receipt of hazardous matedais covered by the manifest except as npre-dXltern 18a <br /> Pdntedit} a Signature Month Day Year <br /> ILI Q <br /> EPA Form 8706-2 (Rev.3-05) Previous editions are obsolete: ESIGNATE F CILtTY DESTINATION STATE(IF REQUIRED) <br /> i <br />