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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFESTrj�l - 010790389 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Smart & Final #403 Smart & Final#403 2094643829 147 N. Wilson Way 147 N. Wilson Way Generator's Phone: Stockton, CA 9152055 6.Transporter 1 Company Name U.S.EPA ID Number t Wast 2olutions inc NINS000110924 7.Transporter 2 Company Name U.S.EPA ID Number k s s u382-13 20, 8,Designated Facility Name and Site Address ::.1st 'Century EMN, LLC U.S.EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 Facility's Phone: 7755752760 NVD980895338 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. o X 1.UN328t r. Waste Corrosive liquid, basic, 2 DF 00130 p 12211 D0021 i.norcjan'ic, n. o. s. (Sodium Hydroxide, Sodium HVnnrhjnritP), A9 Pr, TT, F-iin#j54 LX 2 UN1993, Waste Flammable liquids, n. o. s. 1 DF 00055 p 21 D0011 (Ethanol, Isopropyl Alcohol), 3, PG 11, ERG# X 3UN3264, Waste Corrosive liquid, acidic, 1 DF 00071 P 791; D002( inorganic, n. o. s. (Acetic Acid, Phosphoric Aeid) PQ 11, 9RIGM-54 4. j 14.Special Handling Instructions and Additional Information 1. 101298(Corrosive Basic Liquids) 2. 101300(Flammabie Liquids) 3. 101297(Corrosive Acidic Liquids) 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, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's/Offeror's Printedffyped Name bignature Monthay Year ��, _ /� On I if Smart 8 Final `tel cz. G�r .; 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z Trans orter si nature for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year a z Transp6rter14 a ype Sig ure Mon D y -TeAr � t f ! ! 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLJ C3 1 l I 2 ( / r' ,' 3. 1 � 4. 1 11 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year (LL l I i'1 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNAT FACILITY TO DESTINATION STATE(IF REC:UIRED)