Laserfiche WebLink
C 3542372-001 <br /> 185214-19- -. 002198MPSc <br /> Pl(,ae>e print or tvpe. Form Approved,OMB No 205"039 <br /> UNIFORM HAZARDOUSI Generatot'IO Number 2.Paye 1 m 3.Emergency Response Phone 4.Manifest Tracking Number p O <br /> WASTE MANIFEST CAL060397604 1 (877)577-2669 002198768 PSC <br /> 5.Generator's-Nanm am]MillinyAddrea> Generators Site Address(if different than mailing address) <br /> ROSS STORE#0477 ROSS:STORE.#0477 <br /> $40 W KETTLEMAN LN 340 W KETTLEMAN LM . <br /> LODI,CA 95240.(209)369-1386 LODI,CA 95240 2093691386 <br /> Generalor s Phone:. <br /> " <br /> F. Trarr�porter t Company Name, U.S.EPA ID Number <br /> STERICYCLE SPECIALTY WASTE SOLUTIONS INC MNS000110924 <br /> 1 fransorti r 2 Company Name. c <br /> e <br /> 8.Deserinated Facility Name.,nis Sde Address U.S.EPA ID Number <br /> gist Century Environmental Management of Nevada LLC NVD980895338 <br /> 2095 Newlands Dr..EBst, <br /> Fernley NV 89408 (775)57572760 <br /> F ai:illy s Phone: — <br /> 9a. <br /> 9h.U.S.DOT De.wiplwn(including Proper Shipping Name,Hazard Class;1D N[xnber, 10.Containers 11:Total 12.Unit <br /> lit�4. <br /> and Packing Groupfif any)). No. Type Ouantly W./Vol. <br /> }3.Waste Codes " <br /> 1 UN2810 WASTE TOXIC,UQUID6,ORGANIC,N.O.S.(LEAD,SILVER)6.1 PGII:. <br /> 331 D006 0008 <br /> Q 1 DF .135 .. P. <br /> :. <C [R}11.; DM6 <br /> cc <br /> LLJ <br /> 14.5{iP[ial Handling InstruchOns afid Additional Intorma,Km'. <br /> SSCI-06-ERG(153)ROSW-1-66-TOXIC LOOSEPACK <br /> 15: 'GENERATOKVOFFEROR"S CERTIRCATION:t hereby dictroe that the Cbratents,of this consignmentare fully and.accurately describe lboiae by the proper shipping name ind ons dasslied'packaged, <br /> m:r keit iuul kn4letedtplacarded„aiad'arE in all respects kl txoper.contiitibn for transport according to applicable alternation(and nationatgwernmentaf aegulat%ixts If export shipanerd.and Fam.the Prtrnary,” <br /> E xpei F 1 c rSi`y that the contents,at th[s consignment co Yam to the terms of the aittach6d EPA Ackno ke4ment of Consent <br /> I cenify that 11 waste minimization statement identified in.40:GFR 262.2Ma)(if I am a large quantity gener5tor)or(h)(if tin 1 smalfytaantdy generaiot)is true: <br /> Gen `tnr.,lOffercKs , tecflTypedMame S -2 Dal' <br /> TGlordti <br /> � 16 tnEcr�r[t,onai Shipmer�,s. ' <br /> part to U.S. , ❑kxpoil from U S, - port of enlry(exd <br /> Z Transpodct signature(foe exportsonly): Date ayirig.0 S <br /> W 17,iranspoder Acknowlei god o,Receipt of M atoriah;. X. <br /> Traiis}rodcr 1I>rinterllTypeilNa[ne Sure Yeiir <br /> At?1ay 1llfillcz <br /> la;)Of" <br /> han3podcr 2 PrinterlRyped Name Stature Month r, Year <br /> 18 Diretetiancy .• ..'. -, - <br /> t&1,Uts[iep lncy fndiCatxut Space CO t1[tanldy.. Type Residue Padlai Re)ectrrte . a flejec7) <br /> T �•.' <br /> Manifest Number> <br /> 13b.r11t[rr.atP facility(or Generator) <br /> .: U.S.EPA ID-Number <br /> a`Ti t ariiily s Phone fytoofsth pay Year <br /> it3t 'Sign?lumtif:Aterraale F ac�Nty urGenernta1) <br /> .. <br /> al Meihud L'ones.(O,Oidet;fa`fiazacrloiis waste trent,di lzgl:and <br /> � ta.:H;a7ar[MirsWasteRefiadi�anayemrt (. ,. Sp <br /> , <br /> -1 M <br /> 20."(7trsayttatad T arilAy thvt r or.O i:atnr:CedYtcalimtof rat eq>t of hazaiditus maleria{s covergd by the manifee'exec t ac iiiiect to tterri 16e, ° <br /> friar f' ix[FName <br /> :Strmai.re .: <br /> EPA Foam 8700 29(lieu i2-17) Previous�d�6otts`arP ohso(el DESIGNATE[}PAC[a To tPA'S,IMAM ST'S' 3 EM <br />