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<br /> —96�Z7-20":: 0Q2693076PSG 3887071-06
<br /> type,.._ >roare(I E?Mr No 2050(IU3tl
<br /> Forth App
<br /> {;)+lJr'ow HAZARDOUS General Itt PJ,rt,ber, 2:page f of. I Emergency Re.,p,r>e Phone 14.Mandest Tracking Number
<br /> tupffisrr..MANIFEST CAL000397504 (877)577-2669 002693076PSC
<br /> Generator's SteAddrt s(ift]illricn,cgan matting address)
<br /> ROSS STORE#0477 ROSS STORE#0477
<br /> 340 W KETTLEMAN LN 340 W KETTLEMAN LN
<br /> LODI,CA 95240(209)369-1.386 LODI,CA 95240 2093691386
<br /> rd c
<br /> ;i r..l,Grtt r nan<aEv Hann,
<br /> U:i t;fAlDNumber
<br /> STERICYCLE-SPECIALTY WASTE SOLUTIONS INC MNS000116924
<br /> fr;itrr,rc rtt,?t:0ntfri;ny Nmpec U.S.EPAID Number
<br /> !)_>,;r r i i.F ri;Nfy Nrame"rod Site Adilre5s U.S:EPA ID Number
<br /> GENERAL ENVIRONMENTAL MGT LLC DBA PSC ENVIRONMENTAL SERVICES. CAD980884183
<br /> 11855 WHITE ROCK ROAD,
<br /> RANCHO CORDOVA CA 95742 (916)351-0980
<br /> t aC-t D Fr--:r r c ,drr I t rr Shpt-c;Jame ti tz aril Ci us.ID tvurnb�'r 1o.Containers 1 t lotal 12.iJnd
<br /> r .i;., ,.•L12 W ante Codes
<br /> No. Type Quantity NA.;Voi.
<br /> X
<br /> Z UN1993 WASTE FLAMMABLE LIQUIDS,N.O.S..(ACETONE)3 PGA
<br /> X
<br /> 331 D001:-
<br /> O
<br /> 2 F 23 P
<br /> f
<br /> t `asf �1„,. " �ahs t,d Ardddi0nal hrtirrnai�on
<br /> (2)ROSSFLAMM-07-ERG(128)ROSSFLAMM-07-FLAMMABLE LOOSEPACK.
<br /> 6.,GENE RATCIR'SI()FF50r.S CERTIFICATION: i I tereby derlare thal.the contents(A lh c unAnmenl are fwly and accur,Itely described above bythe proper sivpping name:and are rlasstfied.riackag0.
<br /> al,trk i aar fi I,abolod'placarc{eti,<rr:t,are t all rn;pect°s in proper con(4tinn fbr trap+sport�1c(nrdmq{o.app cable international and nolional governmental rquiations.l{export shipment and)ant tho Primary
<br /> t? t '. frlif0hat the conierits of this t onsitpariient.rantorm Cra the terms(if lie attacheC1 El''A 4cknot+fedymetti cif Giament
<br /> a„Y t ret rhr7ahgn:iatemenl idevihfted in 40 CFR 1612 (x)(!1 erm as l(tcrit,tlrraritify(Ifuerator},or R'.!(il lam a small gitrtnhty get;erator)is iter•.
<br /> b. :r'ruYcc'rypedName Signal- hn:n.+: !'ay Y07.
<br /> bl e 2 25 20
<br /> '.mpr t.t ITS. El I xport from U S Port or anttytex t.
<br /> t Date c.Eving U.S,
<br /> t>* 1 I,,,r„si a..".n:,:I.";a,e.;ti. I�,( oft atcriaiti.
<br /> hti rhlU:r`t cn Ns;mF Signature. Month Oav Year.
<br /> a Andy Winkler.. 2 25 211
<br /> r ar spar: r `Print{Kli typed Name Signature: Month Ua:/. Year
<br /> <t
<br /> l8a.Distrc,tamy indication,Space Quantity ❑Tytie
<br /> ❑Residue0 Partial Rejection �`FuEf Re)cctinn,
<br /> P anifest Referemce Number:
<br /> _ U.S.EPA ID NOmber
<br /> J
<br /> '18;-1'Rvja[t,11v of Afternale farrii(y(or Generalor) r
<br /> Month Day Year
<br /> 1a
<br /> I r?.1 i:irar(Iriirs Waste Report Management Method Godes(i.e.,codes for hazardous waste(reatment.,disposal,and reryrlinil systems)
<br /> 1 2. g. 4
<br /> H1.41
<br /> :'.i?::Dia innata rJ 8(:1,03 Owner or Opermlor.Cerlificulion of rece.00 hazardous materials covered.tiy the manifest except as.noted.in Item 16.a
<br /> I n,rxJ;f p'I a c Name Sicjnafure. I Month Day Year
<br /> �,',"
<br /> 12-171 Previous Previousvdittoiif,,atoN)blete. DESI�a T FACILITYTE)EPA's 2 E(r�A�IiF Si S�'�T�PdI
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