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5:8# 12-a� �unAUNUNNNANN.ikMiV .h <br /> Plea sbpnnt4rtype. _ 002572246PSt <br /> UNtFOit(yf HAZAI30QUS 1.Generator i}7 Number 2:PagejaflEmergency Response Phone 4.Manifest Tracking umberov50 <br /> WASTEMANIFEST CAL000397504187 5�7-2669 <br /> 5 Generator's Nameand Marling Address 0026,2246PS <br /> ROSS STORE#0477 Generators Site Address(9 dAferent lFiao maifuig address) <br /> 340 W KETTLEMAN LN ROSS STORE#0477. . <br /> LODI,CA 95240 340 W KETTLEMAN LN <br /> (209)389-1386 LODI,CA 95240 2093691386 <br /> Genertntor's Phone: <br /> Transporter.1 Con <br /> SPECIALTY WASTE SOLUTIONS INC Us.EPA ID Number <br /> 7'Transporter 2 C.ompariy Name <br /> MNS000I 10924 <br /> U.S.ENA ID Number <br /> 8.Designated FacilityName acid Site Address <br /> ress <br /> GENERAL ENVIRONMENTAL MOT LLC DBA PSC ENVIRONMENTAL SERVICES U.S.EPA ID Number <br /> 11855 WHITE ROCK ROAD, CAD980884183 <br /> RANCHO CORDOVA CA 95742 (916)351-0980 <br /> Farility,.Phone: _ <br /> 9a 9h.U.S.DOT Description(including proper Shipping Name.Hazard Class,ID Number, <br /> HM and Packing Group(if any)) 10.Containers 11 Total 72.Unit 13.Waste Codes <br /> T. UN1869 WAS E AEROSOLS 22 Na. Type Quantity Wt,lvol: <br /> O )( <br /> pQC <br /> OF 7. P <br /> D001 <br /> W 2,..WNJVW WASTE FLAMMABLE LIQUIDS,N.O.S.(ACETONE)3 PGH <br /> C2 . X <br /> Dow .. <br /> 1 DF. 7'` p <br /> 14 Special Handling Ir}SUuetloas art :Addltronal Information <br /> f1)R9SSAEROdi7 ERG(126,ROSSAEiiO U7.AEROSOLS(2)gpgSFLAMM 07 ERG(128)ROSSFLAMM-0T-FLAMMABLE LUOSEPACK <br /> 15: GENERAT4lR$/GFERUR SGERTIFICATION I hereby declare that the contents of this consignment are fully grid accurately descnbeif iatiove by tris proper shipping <br /> marked and labelecifj arorded,and are in alt respects ircproper conrJf(ion for trAnsport according to appikable international and national govemrr�nfalieproper o arae,and are classified;packaged, <br /> Exporter;I certify that the contents of this consignment opnForm:fo fire terms of the attached EPA Acknowledgment of Consent. g export shipment.and i am the primary <br /> I certify that the waste 11 11 11minimization statement rdepbfied m 40 CFR 42Z(a).(if I am a large quantify generator)or(b}{if I aril a small quaMly generaiar)is true. <br /> Geiie en s PrintedfTyped Name <br /> Signature <br /> 6+�Gu Month Day Year:. <br /> -w 1B Int ema- Slrgnlenls-" 11 i4 - 19 <br /> 1" - ❑Import to U.S. <br /> ? Transporter signature(for-expods only): ElExport from U.S. it of entry/exiE: <br /> W IT Transporter Date leaving U.S.: — -- -- <br /> w 9nrentof Receipt of Materials <br /> TransporEer 1 Printed,Type' am <br /> O <br /> vt.✓t� 1/"t 0 Year <br /> Trahspartet <br /> 2'P <br /> rintedRype l ams <br /> Signature.. <br /> 14 11 <br /> t6.a�reparxry: , <br /> Morilh . Day Year . <br /> 18a:ofSerepancje fndtcatfon ". <br /> Qtlantlly ©Type i <br /> Residue O partial Rejection .Fulf fiefe[gkin <br /> iBb.Altemate'Farai4yfvJanif"LReference Number- <br /> v U.S.EPA ID Number <br /> W Farattys Phone:- <br /> 18c,Sfgnafure of AAernatelSy-(or Generator) <br /> CD- <br /> 19 Hazarclaus. Mor181 ay year <br /> w e + nlErylathodCodps(Ie cpQp <br /> 1 SM waste treaunenC disposal Grid Zrrrecycling systems) <br /> 1 8, <br /> e' is irks <br /> 6�ttierriam'[epf, pt as n'deli•xI ltemlf)i1: `;: _ <br /> .z `Norah Qalf <br /> EPA For1Yf 8 lrfins"We? ` <br /> D SIGNRTA #Lt TO ERA's a1 � 5� <br />