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1038?I�-75 <br /> Now- <br /> 002151904F'$6 <br /> a=- <br /> 1NIFt)RM HAZARDOUS i Generate ID Ntm'ber, 2..Rage 1 3 Emergency Response Phone #Iu{arrifestTr`acking u#Iytx�' <br /> WASTE Tf�AN)FEST Cit=' 397504 1 Wn 5Tf-26 --[--- <br /> 69 <br /> t� r� a <br /> ;.'.�erera"ar s Narrre acrd Mailetg Adduces Generator's Site Addres4(it different than ma�inga<tdress) <br /> ROSS STORE#0477 ROSS STORE#0477 <br /> 340 W KETTLEMAN LN 340 W KETTLEMAN LN . <br /> LODI,CA 95240(209)369-13$6 LODI,CA 95240 26936973$6 <br /> Genoral>r s Phone: <br /> 4 <br /> F:'I rau p¢rteF I Company Name <br /> U.9= PA Ntunber. <br /> STERICYCLE SP) CIAM WASTE SOLUTIONS.INC. <br /> :. <br /> MN300Q1'f6924 <br /> r'.Tr;tft� tier 2 Cors <br /> fm inpany Name M.�i,. <br /> A De:rgnatntf,FracflAAy Name and Site Address US"EPAfb Number. <br /> 21st Century ewwrainniental Manageme a,af.Nevada LLC M. <br /> NVQ <br /> 338 <br /> 2095 Newlands Dr: <br /> Fernley NV 89408 (775)575-2760 <br /> g;i ao U.S:DOT Desaoiurl(mclirdvg Proper Shipping Name,Hazard Class,ID Nurnber,. }(}Ctl. IS it Tot81.'. 12.Utirt <br /> !ri and Pack=ng frafO,f any)} Type; Ctuantily l3.Waste Codes- <br /> "Not- <br /> No., <br /> i s UN2810 WASTE TOXIC,LIQUIDS,ORGANIC,N,O.S.(LEAD,SILVER)6.1 PGB <br /> CC <br /> X itII R <br /> 33,1. L)006 Dope <br /> Q <br /> D01I•' ,.0018 <br /> 1 UN1993 WASTE FLAMMABLE LtQll103,N O,S.(ACETONE)9 PGB <br /> tJ'3 33i OORt' <br /> X Y. DF. 19 P <br /> 3. <br /> $, <br /> 14.S),)ecial Handling instructions and Additional Information <br /> (1)ROSS6.1-06-ERG(153)ROS".1-08-TOXIC LOOSEPACK(2):�f7.AM M-06-ERG(128► - µpg LOpSEPACK <br /> lfi. GENERAfdR dFFEROR S CERTIFICA(ION:I hereby declare that thecontents of this consignment are fuuy and accurately described above:bythe.proper sliiptiing name,and are ctassriied,paCliagetl, <br /> rrr nk d and felmied/plecarde<I,and are m all respects in proper condition for transport according to applicable International and national governmental regi laltions.tl export shipment and 1 am the Primary` <br /> E xo 2r}r r.I certify thafthe contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I cell ily that the waste minimization statement identified m 40 CFR 26227(a)(ii t am a targe quan4ity generator!or(b){if I am a small quantity gerwratat)is lure:: <br /> Gtner<it�rtir't1f(erorsPrMcvlti fdarnF J g Month Day Yr. <br /> a <br /> r 1 l,rtert +s+mal sh"V its <br /> Import to U.S Export from U.S. - Pad ofentry/exL <br /> }ran+pnrtr r sign;iture(lwexporls only): Date leavirtij U.S.: <br /> LU <br /> '.1ranspw-rterrrknower)gnretofRcu,�knfMateras <br /> I.- 1'rarisporr r T Printedrfypetl Name Sz)natue more Day. Year <br /> Chris Gilliam. . <br /> 3. $. : .j9. <br /> fr<ni,prater 2 Prided-7yped Name Signature. <br /> L.. <br /> Mo2nth 'Day Yanr <br /> 18.Discs,pancy . ��--77 <br /> l8a.Dlsctepanr.,y.Indication Spate LJ Quantity T e <br /> yp ❑Residue ❑Partial Rejection 0 Full Rejection <br /> N9anifest Reference Number <br /> 18y.Memnate Farality(or Generator) <br /> U.-S.EPA ID NrNnber <br /> F,,.l„y's Phone: - - - - - - <br /> Uj <br /> 1&: Signature of Alternate Facility(or.Generator) <br /> MOnIh <br /> Day Year <br /> Z .' <br /> rj5 19.+Iarlydotis Waste Reoort Mafrx)emen.I Method Codes f i.e.;codes for hoz*ps waste treatment,dispose},and recycfmg systems) <br /> w 1 ' <br /> G : H141. 2. <br /> 3. <br /> H141 <br /> 10.DESI(uY.ifed Facility thvner or Operator:Cedification of receipt o(fiaiardous materials covered by the manifest except as rioted in Item I,t3a:. <br /> P, r1`rypi d Name <br /> SiMature MfonLh Day Year: : . <br /> A i�t= <br /> EPA Farm BIQa?_2{Rev.1217} Previous editions are obsolete: <br /> QESI NATEp FACH ITY TO EPA's e•MANIFEST-SYSTEM <br />