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II�III�IIII�II�I�IIRIII�I{I�lllllfl�l��lll�lfll�{ Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number WASTE MANIFEST ICAL000401855 1 1 1 (877) 577-2669 1 014024037 FLE 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Marshalls #M0381 Marshalls#M0381 (209) 365--0992 2429 West Kettiemen Lane 2429 West Kettlemen Lane Generator's Phone: Lodi, CA 95242 Lodi, CA 952242 6.Transporter 1 Company Name U.S.EPA ID Number Steric cle Specialty Waste Solutions Inc MNSOOOII0924 7.Transporter 2 Company Name .44/� G ` U.S.EPA ID Number p w 8.Designated Facility Name and Site Address 21St Century EMN, LLC U.S.EPA ID Number 2095 Newlands Drs. 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 WtWol. X 1UN1993, Waste Flammable liquids, n. o. s. 2 DF 00232 F' 331 D001 D035 a (ALCOHOL, ACETONE), 3, FSG II, ERG#128 --- z 2. w CD j 3. 4. i r 14.Special Handling Instructions and Additional Information 1. 102337(Flammable 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 ational go rnmental 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 Conse . 1 certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I a ' all a ', generator)is true. Geff0s AorOff or r'tedlTyp a e Signature aW)L_f Month Day Year 021 07 120210 16.TKmati5nal Shipments H ❑Import to U.S. ❑Export from U.S. Po of entry/exit: Z Transporter signature(for exports only): leavi S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedfTyped Signature Month Day Year CL 1 021 071202Q Transporter 2 Printed/Typed Name .-; C Signa ure Month Day Year 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 V Facility's Phone: C3 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) G 1. Z 3. 4. R 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 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM 97010-22 12v3 CR!_40 131 9400'24600 -1041673356 M F'D02070 9D020720